Nutrition final jitesh sir

1. NUTRITIONAL PRACTICE IN
PAEDIATRICS
DR. JITESH DOBHAL
DEPT. OF PAEDIATRICS

2. Learning objectives
• Definition and types of nutrients
• Macronutrients-
carbohydrates
proteins
fats
• Micronutrients –
vitamines and minerals
• Nutritional requirement

3. NUTRITION
• Nutrients are the substances required for
growth, development of various tissues and
organs.
• Its also act as a resrvoir of fuel(energy) for
various processes that uses energy for eg
digestion , respiration, excretion etc.

4. Nutritional intakes for infants, children, and
adolescents should provide adequate energy
(calories) for maintenance of current weight and to
support normal growth and development.
The infancy growth period is rapid, critical for neuro-
cognitive development, and has the highest energy
requirements relative to body size compared with
other periods of growth. This growth depends mainly
on nutrition while other phases of growth like
childhood period and pubertal growth depends on
hormones(thyroid , growth and sex hormones).

5. The dietary reference intake( DRI) concepts include the
estimated average requirement (EAR) and the
recommended dietary allowance (RDA). The EAR is
the average daily nutrient intake level estimated to
meet the requirements for 50% of the population,
assuming normal distribution; the RDA is an estimate
of the daily average nutrient intake to meet the
nutritional needs of >97% of the individuals in a
population, and it can be used as a guideline for
individuals to avoid deficiency in the population.

6. • Nutrient can be grouped as macronutrients and
micronutrients
• Macronutrients are needed in large quantity and
it compromises carbohydrates, protein and fat
and they give mainly energy and for growth of
the tissue.
• Micronutrients are needed in tiny quantity and it
compromises vitamins, minerals. They plays an
important role in the metabolism of the body.

7. Carbohydrate
carbohyadrate are the main source of energy (50-60%)
of total energy and <5% should be simple sugar
Carbohydrate contribute taste, texture and bulk to the
diet , lack of carbohydrates may produces ketosis,
wt. loss and breakdown of proteins .
Carbohydrates divides into
Simple carbohydrates(mono and disaccharides)
Complex carbohydrates ( oligo- and polysaccharides
such as starch)
Carbohydrate provide 4kcal of energy per gram.

8. protein
proteins are second most abundant substance in body
after water, they required for growth and synthesis of
tissue in the body , formation of body juices , hormone,
plasma proteins, enzymes and hemoglobin .
Amino acids that can be synthesised in the body are called
non essential while essential amino acids require to be
supplied in the diet
Essential amino acids include leucine, isoleucine, lysine,
methionine, phenylalanine, threonine, tryptophan and
valine
Provide 4 kcal energy per gm.

9. • Food proteins differ in their nutritional quality
depending on their amino acid profile and
digestibility
• Cereals are deficient in lysine and threonine
whereas pulses are rich in lysine and
threonine, so when cereals are taken in
combination with pulses, so deficiency in one
is made good by an excess in other

10. • True digestibility (TD) : -
Nitrogen absorbed / nitrogen intake *100
• Biological value (BV) :-
Nitrogen retained/Nitrogen absorbed* 100
• Net protein utilization :-
True digestibility (TD) *biological value (BV)/100
That is nitrogen intake / nitrogen retained

11. • Egg protein has the highest value of BV and
NPU and is therefore taken as the reference
protein and value of others is expressed as
relative to egg (taken as 100%)
• One egg contain 6 gm of protein
• Other example
Meat-18.5gm/100gm, Chicken-25gm/100gm
Roti-2gm/roti, Rice-4gm/katori

12. Fat
Fat function as structural elements of cell
membrane, are a major source of energy,
carry fat soluble vitamines, and precursors of
prostaglandine and hormones ( cortisol and
sex hormones)
Fat are present in diet in form of fatty acid
(triglycerides), phospholipids and cholesterol.
Provide 9 kcal energey /gm

13. Simple lipids
Saturated fatty acids
Ghee, butter
Unsaturated fatty acids
monosaturated fatty acids
(Olive oil ,palm oil
mustard oil)
polyunaturated fatty acids
(Corn oil soya bean oil )
essential fatty acids
(Linoleic acid
Lenolenic acid)

14. • Fats provide 9 kcal of energy per gram. About 25-
30% of energy intake should be form fat.
However in malnourished children up to 45% of
calories can be provided from fat safely in INDIA
almost 10-15% of fat is derived from invisible fat .
therefore visible fat intake should be restricted to
below 20%. Saturated fat should not exceed 7%
of the total fat intake : polyunsaturated fat
should be restricted to 10% and rest should be
derived from monounsaturated fats. A minimum
of 3% energy should be derived from linoleic acid
and 0.3% from linolenic acid and total cholesterol
intake should not be more than 300mg/day

15. Balanced diet
defined as nutrionally adequate and appropriate
intake of food items that provide all the
nutreints in required amount and proper
proportions
It contains 55-60% of calories from
carbohydrates , 10-12% proteins and 25-30%
fats

16. Micronutrients
• Micronutrient contain vitamins and minerals
Vit A- required for 1) maintenance of vision,
especially night vision 2) maintenance of
epithelial tissues and 3) differentiation of
various tissues, particularly during
reproduction and gestation by regulating gene
expression
Sources- oils extracted from shark and cod liver.
Carrots,dark green leafy vegetables, oranges
and tomatoes
RDA- Infant 1000-1200 IU, Children 1500-1800
IU, Adolescent 2500-3000 IU per day

17. • Vit D- important role in maintaining calcium and
phosphorus homeostasis and mineralisation and
now a days for immuniomodulation
Sources- major source is its synthesis in skin following
exposure to ultravoilet B solar radiation
RDA- neonates- 600-800 IU, infant 400 IU, Children-
600 IU per day
• Vit E- functions as a membrane bound antioxidant.
Sources- vegetables oils and margarine
RDA- neonate 25 IU
3-6mg/kg/day

18. • Vit K- it is a cofactor in post translational
carboxylation of glutamic acid to form
glutamate in liver. It also acts as Coenzyme
during the synthesis of many proteins
involved in blood clotting(factor II, VII, IX, X)
and bone metabolism
Sources- green leafy vegetables, bacterial gut
flora also capable of synthesizing the vitamin,
sufficient to meet daily need
RDA- 5microgram/day at birth
10microgram/day at 2yr

19. • Vit C- Cofactor for reactions requiring
reduced copper or iron metalloenzyme and as
a protective antioxidant
Sources- vegetables (cauliflower), fruits(citrus
and berries)
RDA child – 15-20mg/day
adolescent – 40-60 mg/day

20. Thiamin(vitamin B1) - Coenzyme in the
metabolism of carbohydrates and branched-
chain amino acids.
Sources – milk n milk products , organ meats
(liver and kidney)
RDA - child 0.5 mg/day
adolescent 1mg/day

21. Folic acid – Coenzyme in the metabolism of
nucleic and amino Acids Prevents
Megaloblastic anemia
Sources - Enriched cereal, grains, dark leafy
vegetables, enriched and whole-grain breads
and bread products, fortified ready-to-eat
cereals
RDA - child 150mcg/day
adolescent 300mcg/day

22. Vitamin B6 - Comprises a group of 6 related
compounds: pyridoxal, pyridoxine,
pyridoxamine, and 5 -phosphates (PLP, PNP,′
PMP)
Sources - Fortified cereals, organ meats,
fortified soy-based meat substitutes
RDA – child 0.5 mg/day
adolescent 1mg/day

23. Vitamin B12 (cobalamin ) -Coenzyme in nucleic
acid metabolism Prevents megaloblastic
anemia.
Soucres - Fortified cereals, meat, fish, poultry
RDA – child - 0.5-1.5 mcg/day
adolescent – 2mcg/day

24. Minerals
Calcium – essential for the coagulation
cascade, nerve conduction, and muscle
stimulation.
Sources- milk and dairy products.
RDA – child – 500-800 mg/day
Adolescent – 1000 mg/day

25. Zinc - Essential for proper growth and
development, and an important catalyst for
100 specific enzymes
Sources – Meats, shellfish, legumes, fortified
cereals, whole Grains Acutely zinc
supplements
RDA – child – 3-5mg/day

26. Iron- Critical component of enzymes,
cytochromes, myoglobin, and hemoglobin
Essential for oxygen transport , DNA synthesis
and electron transport
• Sources - Heme sources: meat, poultry, fish
Nonheme sources: dairy, eggs, plant-based
foods, breads, cereals, breakfast foods
• RDA – 8-10mg/day
in adolescent female 15mg/day

27. RDA
age Energy (kcal) Protein(g) Visible fat(g) Iron(mg)
< 6 month 92kcal/kg 1.16g/kg - 46mcg/kg
6-12 80kcal/kg 1.69g/kg 19 05
1-3 yr 1060 16.7 27 9
4-6 yr 1350 20.1 25 13
7-9yr 1690 29.5 30 16
10-12 yr(boys) 2190 39.9 35 21
10-12 yr(girls) 2010 40.4 35 27
13-15(Boys) 2750 54.3 45 32
13-15(girls) 2330 51.9 40 27
16-17(boys) 3020 61.5 50 28
16-17(girls) 2440 55.5 35 26

28. Factors to be considered while
planning food
• Energy density
• Amount of feed
• Consistency of feed
• Frequency of feed
• Hygiene
• Helping the child

29. • Energy density- it is important to give small
energy dense feeds at frequent intervals to
ensure adequate energy intakes by the child
• Amount of feed – at 6 month feed started 1-2
tsp and quantity increased as child gets older
and starts to accept food better
• Consistency – pureed mashed and semisolid
foods begin at 6 month by 8 month infant eat
finger foods by 12 months children can eat the
same type of food as consumed by rest of the
family

30. • Frequency of feeding – 2-3 times / day at 6-8
month of age, 3-4 times/day for 9-24 month
• Hygiene- good hygiene and proper food
handling should be practiced to prevent
infection and malnutrition

31. Questions
Q. what are macronutrient ? Explain in detail
about protein ?
Q. What is balance diet , and explain in detail
about factors to be considered while planning
food in infant?

32. THANK YOU