nutrition in children

1. • DR SHIV RK DUBEY
• MBBS (Hons), MD (Pediatrics)
• KGMU, Lucknow
• SR – AIIMS BHOPAL

2. • RDA stands for Recommended Dietary Allowance, also
commonly known as Recommended Daily Allowances. It
is the recommended daily vitamins and mineral
intake considered adequate for healthy people.
The RDA was last revised in 1989, and is rather
outdated. Parts of it are replaced by the Dietary
Reference Intakes (DRI), the most recent dietary
guidelines by the Food and Nutrition Board of the
Institute of Medicine, National Academy of Sciences,
1997-2001, in a collaboration between the US and
Canada.

3. There are two different types of
nutrients:
• macronutrients;
• micronutrients.
There are three macronutrients
that are essential for health.
These are:
• carbohydrate;
• protein;
• fat.
MICRONUTRIENTS – vitamins and
minerals.

4. • TRACE ELEMENTS CONSTITUTE ___ % OF BODY
WEIGHT ?
(DNB-2014)
• 1%
• 0.1%
• 0.01%
• 0.001%
• MOST ABUNDANT SUBSTANCE IN THE BODY? AIPG
88
• WATER (60%)
• 2nd MOST ABUNDANT SUBSTANCE IN THE BODY ?
AIPG 89
• PROTEIN

5. Carbohydrate
The two types of carbohydrate that
provide dietary energy are starch and
sugars.
Dietary fibre is also a type of carbohydrate
which is not digested to provide energy.
Starchy carbohydrate is an important
source of energy.
1 gram of carbohydrate provides 4 kcal
energy.

6. Structure of carbohydrate
All types of carbohydrate are compounds of carbon, hydrogen and
oxygen.
They can be classified in many different ways. One common way is
according to their structure.
1. Simple carbohydrates – mono and
Disaccharides
2. Complex carbohydrates – oligo and polysaccharides

7. • Which of the following is not an essential AA ? PGI 97
• TYROSINE
• TRYPTOPHAN
• THREONINE
• METHIONINE
• WHICH OF THE FOLLOWING IS NOT AN INDICATOR
OF PROTEIN QUALITY? DNB 05
• AA score
• Biological value
• Protein energy ratio
• True digestibility
• WHAT IS NPU ( net protein utilisation ) ?

8. Protein
Protein is essential for growth and repair and
keeping cells healthy.
Protein also provides energy:
1 gram of protein provides 4kcal.
Essential amino acids = AH ! MeTTh VIL PhLy
Arginine, histidine (semi essential)
methionine, tryptophan, threonine, valine,
isoleucine, leucine, phenyl alanine, lysine.

9. • AA Score = No. of mg of one AA per gm of
protein/ No. of mg of same AA per gm of egg
protein *100
• TD = nitrogen absorbed/ nitrogen intake
• BV = nitrogen retained/ nitrogen absorbed
• NPU = TD × BV
• Egg protein has the highest values for BV and
NPU.
• Generally, animal proteins have a higher BV than
plant proteins.

10. • MCT ( medium chain TG ) are : UPPG 08
• 6-12 carbon length
• 12-18 carbon length
• >18
• None
• Which of the following are immediate source of enenrgy?
• SCT AIPG 05
• MCT
• LCT
• All of the above
• A COMMON SOURCE OF MCT IS_______ ?
• Coconut oil

11. • Major structural element of cell membrane
• Major source of energy
• Carriers for fat soluble vitamins ( A,D,E,K)
• 25-30% of energy intake ( upto 45% in PEM )
• Triglycerides
• MCT ( 6-12 CARBON LENGTH )
• LCT ( >12 )
MCTs are directly transported to portal vein (
immediate source of energy ) – coconut oil and
butter

12. • Cannot be synthesised in the body and have to
be supplemented.
• Linoleic, linolenic, EPA (eicosapentanoic acid)
and DHA (docosahexanoic acid )
• Important component of grey matter and
enhance intellectual performance.

13. All foods provide different types of fatty acids in
varying proportions.
Butter is often described as a ‘saturated fat’ because it has
more saturated fatty acids than unsaturated fatty acids.
Most vegetable oils are described as ‘unsaturated fats’ as
they have more mono- and polyunsaturated fatty acids
than saturated.
Most saturated fats are solid at room temperature and
tend to come from animal sources.
Most unsaturated fats are liquid at room temperature
and are usually from plant sources.

14. Micronutrients
There are two types of micronutrients:
• vitamins;
• minerals.
Vitamins and minerals are needed in
much smaller amounts than
macronutrients. Their amounts are
measured in milligrams (mg) and
micrograms (μg).

15. • Which of the following is a water soluble vitamin ? MPPG
99
• Vit A
• C
• D
• E
• DRI of VIT A IN INFANTS IS ? MPPG 02
• 100-200 MCG
• 300-400 MCG
• 750 MCG
• 1000 MCG
• RDA of a 2 year old child is-----1100/1400/1500/1700 kcal
(AI)

16. Vitamins
There are two groups of vitamins:
• fat-soluble vitamins, which can
be stored in the body, e.g. vitamins
A, D, E, K.
• water-soluble vitamins, which
cannot be stored in the body and
are therefore required daily, e.g. B
vitamins and vitamin C.

17. Fat soluble vitamins
Vitamin A
Vitamin A is needed for:
• dim light vision;
• healthy skin and eyes;
• resistance to infection.
Vitamin A is found in liver and whole milk. It
can also be produced from beta-carotene
provided by dark green leafy vegetables,
carrots and orange coloured fruit.

18. • Infants = 300-400 mcg
• Children = 400-600 mcg
• Adolescents = 750 mcg

19. Vitamin D
Vitamin D is needed for the absorption of calcium
from foods to keep bones and teeth healthy.
A lack of vitamin D causes rickets in children,
where the legs are bent, and osteomalacia in
adults, which causes pain in bones and muscles.
We get most of our vitamin D via the action of
sunlight on skin during the summer months.
Vitamin D is also provided by the diet from oily
fish, meat, eggs, fortified breakfast cereals and
margarine/spreads.

20. • Infants and Children = 400 IU/day (10 mcg)

21. • DEFICIENCY OF WHICH MICRONUTRIENT
CAUSES HEMOLYTIC ANEMIA IN PRE TERM
INFANTS ? AI 08
• A/D/E/K
• ALL INSTITUTIONAL DELIVERIES ARE GIVEN
A IM dose of which micronutrient ?
• A/D/E/K
• TOCOPHEROL is : vit A/D/E/K AI 00

22. • Anti oxidant
• Manifestation of def are – hemolytic anemia,
spinocerebellar disease.
• RDA = normal infants – 0.4 mcg/kg/day
premature infant – 15-20 mg/day may be
required
Sources – vegetable oils, green leafy
vegetables and nuts.

23. • Main role is as a cofactor in ‘post translational
carboxylation’ of glutamic acid to form glutamate
(Gla), which takes place in the liver.
• Sources – green leafy vegetables, normal gut
flora.
• RDA – 1 mg im at birth to all newborns.
• Older children 10-30 mcg/day

24. • PANTOTHENIC ACID is : PGI
98
•B3/B5/B7/B9
• CAN ANYBODY NAME ALL B COMPLEX
VITAMINS ???

25. • B1 – THIAMINE
• B2 – RIBOFLAVIN
• B3 – NIACIN
• B5 – PANTOTHENIC ACID
• B6 – PYRIDOXINE
• B12 – COBALAMINE
• folate

26. • APHONIA/laryngeal nerve palsy is characteristic of which
B COMPLEX vitamin : B1/B2/B3/B5
• Angular cheilosis/ smooth tongue is seen in def of :
• B1/B2/B3/B6
• CASAL NECKLACE is seen in def of: B1/B2/B3/B6

27. Thiamin (vitamin B1)
Thiamin is required to release energy from
carbohydrate.
It is also involved in the normal function of
the nervous system.
Sources of Thiamin (vitamin B1)
• Whole grains;
• Nuts;
• Meat (especially pork);
• Fruit and vegetables;
• Fortified breakfast cereals.

28. • RDA – 0.4 mg/1000 kcal
• Def.- aphonia/laryngeal N palsy, wernicke’s
• Thiamine diphosphate – cofactor for
• Carb metabolism – pyruvate DH,AKG ( Alpha
ketoG ), transketolase
• HMP shunt – NADP
• Nerve conduction – Ach, GABA

29. Riboflavin (vitamin B2)
Riboflavin is required to release energy from protein, carbohydrate
and fat.
It is also involved in the transport and use of iron in the body.
Sources of Riboflavin (vitamin B2)
• Milk;
• Eggs;
• Rice;
• Fortified breakfast cereals;
• Liver;
• Legumes;
• Mushrooms;
• Green vegetables.

30. • Oxidation reduction reaction – FMN and
FAD
• Milk, egg, legumes, mushrooms
• Angular cheilosis, glossitis ( smooth
tongue )

31. Niacin (Vitamin B3)
Niacin is required for the release of energy from food.
Niacin is also required for the normal function of the
skin, mucous membranes and nervous system.
Sources of Niacin
• Meat;
• Wheat and maize flour;
• Eggs;
• Dairy products;
• Yeast.

32. • Niacin/nicotinic acid/nicotinamide
• Def – pellagra, hartnup disease
• 3 D – dermatitis, dementia and diarrhoea
• Casal necklace
• All common food sources – resistant to heating.
• 1 NE = 1 mg niacin = 60 mg tryptophan
• RDA = 6.4-8 NE/1000 kcal.

33. • Deficiency caused by
• Drugs – INH, Penicillamine, steroids, AED,
OCP
• HEMODIALYSIS
FEATURES INCLUDE – irritability, seizures,
vomiting
Oxaluria, oxalic acid bladder stones
VIT B6 DEPENDENT SYNDROMES –
pyridoxine
dependent seizures

34. • PERNICIOUS ANEMIA IS CAUSED DUE TO
DEF OF :
• B12
• INTRINSIC FACTOR
• BOTH
• NONE
• A WOMEN DELIVERED A BABY WITH lumbo
sacral meningomyelocele. Which nutrient def is
mostly attributed?
• What is the treatment?

35. • Only non veg diet
• IF (STOMACH) + B12 --------->
RECEPTOR IN ILEUM-enterohepatic
circulation
• So deficiency in – strict veg, IF def
(pernicious anemia, IBD, ileal resection.
• Hyperpigmentation of knuckles, involuntary
movements, developmental regression.

36. • Deficiency in pregnancy causes NTDs.
• 400 mcg/day before conception and in first
trimester of pregnancy.

37. • KESHAN DISEASE is caused by def of
• SELENIUM ( CARDIOMYOPATHY )
• GLUCOSE INTOLERANCE/DIABETES has
been attributed due to def of which trace
element:
• CHROMIUM

38. Vitamin C
Vitamin C is needed to make collagen. This is
required for the structure and function of
skin, cartilage and bones.
It is an important nutrient for healing cuts
and wounds.
Did you know?
Vitamin C can help with the absorption of
iron when foods or drink containing both
vitamin C and iron are eaten at the same
meal.

39. Sources of vitamin C
• Fresh fruit especially citrus fruits and berries;
• Green vegetables;
• Peppers;
• Tomatoes;
• New potatoes.

40. Minerals
Minerals are inorganic substances required
by the body in small amounts for a variety of
different functions.
The body requires different amounts of each
mineral.
People have different requirements,
according to their:
• age;
• gender;
• physiological state (e.g. pregnancy).

41. Calcium
The body contains more calcium than
any other mineral. It is essential for a
number of important functions such as
the maintenance of bones and teeth,
blood clotting and normal muscle
function.
Did you know?
The skeleton contains about 99% of the
body’s calcium with approximately 1kg
present in adult bones.

42. Sources of calcium
Milk, cheese and other dairy products are
good sources of calcium in the diet.
Calcium is also provided by :
• broccoli;
• cabbage;
• fortified soya products;
• fish eaten with the bones, e.g.
sardines, tinned salmon.

43. Iron
Iron is essential for the formation of
haemoglobin in red blood cells.
Red blood cells carry oxygen and transport it
around the body.
Iron is also required for normal metabolism and
removing waste substances from the body.
Did you know?
There are two types of iron; one from animals
sources and the other from plant sources.

44. Sources of iron
• Liver;
• Red meat;
• Pulses;
• Nuts;
• Eggs;
• Dried fruits;
• Fish;
• Whole grains;
• Dark green leafy vegetables.

45. Iron in the diet
A lack of iron in the diet means that the stores in the
body will run out.
This can lead to anaemia.
Women and teenage girls need to ensure they have
enough because their requirements are higher than
those of men of the same age due to menstruation.

46. Sodium
Sodium is found in all cells and body fluids.
It is needed for regulating the amount of
water and other substances in the body.

47. Sources of sodium
Most raw foods contain very small
amounts of sodium chloride (salt).
Salt is often added during the processing,
preparation, preservation and serving of
foods.
About 20% of salt we eat is added at
home during cooking and at the table.

48. High sodium intake is considered to
be one of the risk factors for high
blood pressure, which may lead to
heart disease and stroke.

50. Recommended Daily Allowances (RDA) Chart for Infants & Children
NUTRIENT 0-6 mths 7-12mths 1-3 yrs 4-8 yrs
RDA Vitamins (Per Day)
vitamin A - retinol 400* µg 500* µg 300 µg 400 µg
vitamin C - ascorbic acid 40* mg 50* mg 15 mg 25 mg
vitamin D 5* µg 5* µg 5* µg 5* µg
vitamin E 4* mg 5* mg 6 mg 7 mg
vitamin K 2.0* µg 2.5* µg 30* µg 55* µg
vitamin B1 - thiamin 0.2* mg 0.3* mg 0.5 mg 0.6 mg
vitamin B2 - riboflavin 0.3* mg 0.4* mg 0.5 mg 0.6 mg
vitamin B3 - niacin 2* mg 4* mg 6 mg 8 mg
vitamin B5 - pantothenic acid 1.7* mg 1.8* mg 2* mg 3* mg
vitamin B6 - pyridoxine 0.1* mg 0.3* mg 0.5 mg 0.6 mg
vitamin B12 - cyanocobalamin 0.4* µg 0.5* µg 0.9 µg 1.2 µg
biotin 5* µg 6* µg 8* µg 12* µg
choline 125* mg 150* mg 200* mg 250* mg
folate - folic acid 65* µg 80* µg 150 µg 200 µg
Recommended Daily Allowances for Minerals
calcium 210* mg 270* mg 500* mg 800* mg
chromium 0.2* µg 5.5* µg 11* µg 15* µg
copper 200* µg 220* µg 340 µg 440 µg
fluoride 0.01* mg 0.5* mg 0.7* mg 1* mg
iodine 110* µg 130* µg 90 µg 90 µg
iron 0.27* mg 11 mg 7 mg 10 mg
magnesium 30* mg 75* mg 80 mg 130 mg
manganese 0.003* mg 0.6* mg 1.2* mg 1.5* mg
molybdenum 2* µg 3* µg 17 µg 22 µg
phosphorus 100* mg 275* mg 460 mg 500 mg
selenium 15* µg 20* µg 20 µg 30 µg
zinc 2* mg 3 mg 3 mg 5 mg
potassium 0.4* g 0.7* g 3.0* g 3.8* g
sodium 0.12* g 0.37* g 1.0* g 1.2* g

51. Recommended Daily Allowances for Older Children (9 to 18 Years)
NUTRIENT
Male
9-13 Yrs
Male
14-18 Yrs
Female
9-13 Yrs
Female
14-18 Yrs
RDA Vitamins (Per Day)
vitamin A - retinol 600 µg 900 µg 600 µg 700 µg
vitamin C - ascorbic acid 45 mg 75 mg 45 mg 65 mg
vitamin D #1 5* µg 5* µg 5* µg 5* µg
vitamin E 11 mg 15 mg 11 mg 15 mg
vitamin K 60* µg 75* µg 60* µg 75* µg
vitamin B1 - thiamin 0.9 mg 1.2 mg 0.9 mg 1.0 mg
vitamin B2 - riboflavin 0.9 mg 1.3 mg 0.9 mg 1.0 mg
vitamin B3 - niacin 12 mg 16 mg 12 mg 14 mg
vitamin B5 - pantothenic acid 4* mg 5* mg 4* mg 5* mg
vitamin B6 - pyridoxine 1.0 mg 1.3 mg 1.0 mg 1.2 mg
vitamin B12 - cyanocobalamin 1.8 µg 2.4 µg 1.8 µg 2.4 µg
biotin 20* µg 25* µg 20* µg 25* µg
choline 375* mg 550* mg 375* mg 400* mg
folate - folic acid #3 300 µg 400 µg 300 µg 400 µg
Recommended Daily Allowances for Minerals
calcium 1300* mg 1300* mg 1300* mg 1300* mg
chromium 25* µg 35* µg 21* µg 24* µg
copper 700 µg 890 µg 700 µg 890 µg
fluoride 2* mg 3* mg 2* mg 3* mg
iodine 120 µg 150 µg 120 µg 150 µg
iron 8 mg 11 mg 8 mg 15 mg
magnesium 240 mg 410 mg 240 mg 360 mg
manganese 1.9* mg 2.2* mg 1.6* mg 1.6* mg
molybdenum 34 µg 43 µg 34 µg 43 µg
phosphorus 1250 mg 1250 mg 1250 mg 1250 mg
selenium 40 µg 55 µg 40 µg 55 µg
zinc 8 mg 11 mg 8 mg 9 mg
potassium 4.5* g 4.7* g 4.5* g 4.7* g

52. Recommended Daily Allowances for Adults (19 Years and Up)
NUTRIENT
Male
19-50 Yrs
Male
>50 Yrs
Female
19-50 Yrs
Female
>50 Yrs
RDA Vitamins (Per Day)
vitamin A - retinol 900 µg 900 µg 700 µg 700 µg
vitamin C - ascorbic acid 90 mg 90 mg 75 mg 75 mg
vitamin D #1 #5 5* µg 10* µg 5* µg 10* µg
vitamin E 15 mg 15 mg 15 mg 15 mg
vitamin K 120* µg 120* µg 90* µg 90* µg
vitamin B1 - thiamin 1.2 mg 1.2 mg 1.1 mg 1.1 mg
vitamin B2 - riboflavin 1.3 mg 1.3 mg 1.1 mg 1.1 mg
vitamin B3 - niacin 16 mg 16 mg 14 mg 14 mg
vitamin B5 - pantothenic acid 5* mg 5* mg 5* mg 5* mg
vitamin B6 - pyridoxine 1.3 mg 1.7 mg 1.3 mg 1.5 mg
vitamin B12 #2 2.4 µg 2.4 µg 2.4 µg 2.4 µg
biotin 30* µg 30* µg 30* µg 30* µg
choline 550* mg 550* mg 425* mg 425* mg
folate - folic acid #3 400 µg 400 µg 400 µg 400 µg
Recommended Daily Allowances for Minerals
calcium 1000* mg 1200* mg 1000* mg 1200* mg
chromium 35* µg 30* µg 25* µg 20* µg
copper 900 µg 900 µg 900 µg 900 µg
fluoride 4* mg 4* mg 3* mg 3* mg
iodine 150 µg 150 µg 150 µg 150 µg
iron 8 mg 8 mg 18 mg 8 mg
magnesium #4 400/420 mg 420 mg 310/320 mg 320 mg
manganese 2.3* mg 2.3* mg 1.8* mg 1.8* mg
molybdenum 45 µg 45 µg 45 µg 45 µg
phosphorus 700 mg 700 mg 700 mg 700 mg
selenium 55 µg 55 µg 55 µg 55 µg
zinc 11 mg 11 mg 8 mg 8 mg
potassium 4.7* g 4.7* g 4.7* g 4.7* g
sodium #5 1.5* g 1.3* g 1.5* g 1.3* g

53. Recommended Daily Allowances for Pregnancy / Lactating Mothers
NUTRIENT
Pregnancy
14-18 Yrs
Pregnancy
19-50 Yrs
Lactation
14-18 Yrs
Lactation
19-50 Yrs
Recommended Daily Allowances for Vitamins
vitamin A - retinol 750 µg 770 µg 1200 µg 1300 µg
vitamin C - ascorbic acid 80 mg 85 mg 115 mg 120 mg
vitamin D #1 5* µg 5* µg 5* µg 5* µg
vitamin E 15 mg 15 mg 19 mg 19 mg
vitamin K 75* µg 90* µg 75* µg 90* µg
vitamin B1 - thiamin 1.4 mg 1.4 mg 1.4 mg 1.4 mg
vitamin B2 - riboflavin 1.4 mg 1.4 mg 1.6 mg 1.6 mg
vitamin B3 - niacin 18 mg 18 mg 17 mg 17 mg
vitamin B5 - pantothenic acid 6* mg 6* mg 7* mg 7* mg
vitamin B6 - pyridoxine 1.9 mg 1.9 mg 2.0 mg 2.0 mg
vitamin B12 2.6 µg 2.6 µg 2.8 µg 2.8 µg
biotin 30* µg 30* µg 35* µg 35* µg
choline 450* mg 450* mg 550* mg 550* mg
folate - folic acid #3 600 µg 600 µg 500 µg 500 µg
Recommended Daily Allowances for Minerals
calcium 1300* mg 1000* mg 1300* mg 1000* mg
chromium 29* µg 30* µg 44* µg 45* µg
copper 1000 µg 1000 µg 1300 µg 1300 µg
fluoride 3* mg 3* mg 3* mg 3* mg
iodine 220 µg 220 µg 290 µg 290 µg
iron 27 mg 27 mg 10 mg 9 mg
magnesium #6 400 mg 350/360 mg 360 mg 310/320 mg
manganese 2.0* mg 2.0* mg 2.6* mg 2.6* mg
molybdenum 50 µg 50 µg 50 µg 50 µg
phosphorus 1250 mg 700 mg 1250 mg 700 mg
selenium 60 µg 60 µg 70 µg 70 µg
zinc 12 mg 11 mg 13 mg 12 mg
potassium 4.7* g 4.7* g 5.1* g 5.1* g

54. • About RDA
The Recommended Daily Allowances below incorporate
the DRI figures.
Recommended Daily Allowances / Dietary Reference
Intake
In the Recommended Dietary Allowance charts below,
amounts marked with a * indicate AI (Adequate Intake)
figures taken from the Dietary Reference Intakes (DRI).

55. • #1 As cholecalciferol. 1 µg cholecalciferol = 40 IU vitamin D.
• #2 : As 10 to 30 percent of older people may malabsorb food-bound
B12, FNB advises those older than 50 years to meet their
Recommended Daily Allowances for it by consuming foods fortified
with B12 or a supplement containing B12.
• #3 : In view of evidence linking folate deficiency with neural tube
defects in the fetus, FNB recommends that women capable of
becoming pregnant consume 400 µg of folate from supplements or
fortified foods, in addition to intake of food folate from a varied diet.
• #4 : Men from 31 to 50 need slightly more magnesium (420 mg) than
those from 19 to 30 years old (400 mg). Women from 31 to 50 also
need slightly more magnesium (320 mg) than those from 19 to 30
years old (310 mg).
#5 : Adults over 70 years need slightly different levels of vitamin D
(15µg), sodium (1.2g), and chloride (1.8g).
• #6: Pregnant women from 31 to 50 need slightly more magnesium
(360 mg) than those between 19 to 30 years old (350 mg). Women
from 31 to 50 who are breastfeeding also require slightly more
magnesium (320 mg) than those between 19 to 30 years old (310
mg).