Nutrients And Assessment

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Nutrients And Assessment

  1. 1. NUTRIENTS and ASSESSMENT Myrna D.C. San Pedro, MD, FPPS
  2. 2. Specific Objectives <ul><li>To discuss the importance of nutrition </li></ul><ul><ul><li>Correlate nutrition with growth </li></ul></ul><ul><ul><li>Define nutrition and other associated terms </li></ul></ul><ul><ul><li>Discuss energy requirement and expenditure </li></ul></ul><ul><ul><li>Discuss body composition and growth </li></ul></ul><ul><li>To discuss all essential nutrients as to their functions, sources and requirements </li></ul><ul><li>To discuss a comprehensive pediatric nutritional assessment </li></ul>
  3. 3. NUTRITION & GROWTH <ul><li>Unique nutritional needs of infants and children </li></ul><ul><ul><li>Rapid growth especially during 1 st year of life </li></ul></ul><ul><ul><ul><li>3-fold increase in weight </li></ul></ul></ul><ul><ul><ul><li>50% increase in length </li></ul></ul></ul><ul><ul><li>Higher metabolic rates </li></ul></ul><ul><ul><li>Marked developmental organ changes </li></ul></ul><ul><li>Good nutrition helps </li></ul><ul><ul><li>Develop physical and mental potential </li></ul></ul><ul><ul><li>Provide reserves for stress </li></ul></ul><ul><ul><li>Prevent acute and chronic illness </li></ul></ul>
  4. 4. NUTRITION <ul><li>Combination of processes by which </li></ul><ul><li>Organism receives & uses materials </li></ul><ul><li>Needed for </li></ul><ul><ul><li>Growth </li></ul></ul><ul><ul><li>Functions </li></ul></ul><ul><ul><li>Repair of parts </li></ul></ul>
  5. 5. METABOLISM <ul><li>All the changes in foodstuffs </li></ul><ul><li>From absorption in the GIT until </li></ul><ul><li>Elimination by excretory organs </li></ul>
  6. 6. NUTRIENT REQUIREMENT <ul><li>Amount needed </li></ul><ul><li>To replace obligatory losses </li></ul><ul><li>To support synthesis </li></ul><ul><li>Varies by age, sex, size & growth rate </li></ul>
  7. 7. ENERGY EXPENDITURE <ul><li>Basal Metabolic Rate (BMR) </li></ul><ul><li>Specific Dynamic Action (SDA) or Thermic Effect of Food (TEF) </li></ul><ul><li>Body activity </li></ul><ul><li>Fecal losses </li></ul><ul><li>Growth allowance </li></ul>
  8. 8. <ul><li>Basal Metabolic Rate (BMR) </li></ul><ul><li>Energy expenditure of awake individual </li></ul><ul><ul><li>At rest </li></ul></ul><ul><ul><li>At room temperature (20 0 C) </li></ul></ul><ul><ul><li>After overnight or 14 hours fasting </li></ul></ul><ul><li>Most closely related to lean body mass </li></ul><ul><li>Factors: metabolic disorders, surgery, infections, anorexia or fever* </li></ul><ul><li>50-100% in infants and 20-25% in adults to maintain temperature </li></ul><ul><li>In infants about 55 kcal ** /kg/day which decreases to 25-30 kcal/kg/day at maturity </li></ul>
  9. 9. <ul><li>Specific Dynamic Action (SDA) or Thermic Effect of Food (TEF) </li></ul><ul><li>Increase in heat production due to digestion and assimilation of food </li></ul><ul><li>Highest for proteins (30%) but low for carbohydrates (6%) and fat (4%) </li></ul><ul><li>In infants about 7-8% of intake but in older children not more than 5% </li></ul><ul><li>About 5 kcal/kg/day </li></ul>
  10. 10. <ul><li>Body activity (physical & exercise): average need is 15-25 kcal/kg/day but may be as high as 50-80 kcal/kg/day for short periods </li></ul><ul><li>Fecal losses: amount of energy-producing food in stools (unused fats & proteins) not more than 10% of intake or about 8 kcal/kg/day </li></ul><ul><li>Growth allowance: during 1 st 4 mo about 15-20 kcal/kg/day which decreases to 12 kcal/kg/day at end 1 st year </li></ul>
  11. 11. Thus, the energy requirement of the infant or child is the level of intake which can Maintain appropriate body size & composition As well as deposition of new tissues Meet the energy required for physical activity And the thermic effect of food
  12. 12. Daily Caloric Requirement <ul><li>Approximately 80-120 kcal/kg body weight for the 1 st year </li></ul><ul><li>Decreasing subsequently by about 10 kcal/kg body weight every 3-year period </li></ul>
  13. 13. Energy Expenditure 6-12 Years <ul><li>Basal metabolism 50% </li></ul><ul><li>SDA or TEF 5% </li></ul><ul><li>Physical activity 25% </li></ul><ul><li>Fecal loss 8% </li></ul><ul><li>Growth 12% </li></ul>
  14. 14. Body Composition <ul><li>Fat-free mass (FFM) * component consists of: </li></ul><ul><ul><li>Water 60-65% body weight (BW) adults while 70-75% BW infants </li></ul></ul><ul><ul><li>Proteins 20% BW adults </li></ul></ul><ul><ul><li>Carbohydrates not more than 1% BW </li></ul></ul><ul><ul><li>Mineral content 4.35% BW adults but 3% BW at birth </li></ul></ul><ul><li>Fat mass (FM) component: 13-17% BW (or not >25%) in males and 20-25% (or not >30%) BW in females 6-18 years of age** </li></ul><ul><li>Why the need to know and measure body composition: </li></ul><ul><ul><li>The rising prevalence of childhood obesity (>FM) </li></ul></ul><ul><ul><li>For assessment and treatment of growth disorders </li></ul></ul><ul><ul><li>An important index of energy and fluid requirements (FFM size) during artificial nutrition </li></ul></ul>
  15. 15. MAJOR NUTRIENTS <ul><li>Carbohydrates </li></ul><ul><li>Proteins </li></ul><ul><li>Fats </li></ul><ul><li>Water </li></ul><ul><li>Minerals </li></ul><ul><li>Vitamins </li></ul>Macronutrients Micronutrients
  16. 16. Macronutrients Provide Energy <ul><li>Carbohydrates (CHO): 1 g = 4 kcal </li></ul><ul><ul><li>Enough CHO to prevent ketosis and/or hypoglycemia = 5 g/kg/24 hr </li></ul></ul><ul><li>Proteins: 1 g = 4 kcal </li></ul><ul><li>Fats : 1 g long-chain = 9 kcal </li></ul><ul><ul><ul><li>1 g medium-chain = 8.3 kcal </li></ul></ul></ul><ul><ul><ul><li>1 g short-chain = 5.3 kcal </li></ul></ul></ul><ul><ul><li>Enough fat to provide essential fatty acid (EFA) requirements = 0.5-1 g/kg/24 hr </li></ul></ul><ul><li>Thus, minimal needs for CHO and fats not more than 30 kcal/kg/24 hr or only about 1/3 of total energy needs </li></ul>
  17. 18. Carbohydrates’ Functions <ul><li>Readily available & supply most of body’s energy needs </li></ul><ul><ul><li>Primary role to provide energy to cells in body, especially the brain - the only carbohydrate-dependent organ in body </li></ul></ul><ul><li>Antiketogenic </li></ul><ul><li>Structure of cells </li></ul><ul><li>Store calories as glycogen </li></ul><ul><li>Convert to fat </li></ul><ul><li>Amino acid synthesis </li></ul><ul><li>Fiber: Dietary (e.g. cellulose) & Functional (e.g. Psyllium) </li></ul><ul><ul><li>Promote normal laxation, help prevent diet-related cancer, help reduce serum cholesterol levels, hence, risk of coronary heart disease (CHD) and help prevent obesity and risk of adult-onset diabetes </li></ul></ul>
  18. 20. Proteins’ Functions <ul><li>Supply amino acids for growth & repair of body tissues </li></ul><ul><li>Supply ions in acid-base balance </li></ul><ul><li>Part of hemoglobin, nucleoproteins, glycoproteins & lipoproteins </li></ul><ul><li>As enzymes, hormones, antibodies & cellular respiratory substances </li></ul><ul><li>Protective structure (nails & hair) </li></ul><ul><li>Source of energy when there is shortage of fats & carbohydrates </li></ul>
  19. 22. Daily Protein Requirement 1.2 16-19 yr Males 0.85 (or 46 g/day of protein) 0.80 (or 46 g/day of protein) 14-18 yr (RDA) 19-30 yr (RDA) Females As point of reference: 3 ounces lean beef (the size of a deck of cards) or poultry = 25 g protein; 3 ounces fish or 1 cup soybeans = 20 g protein; 1 cup milk or yogurt = 8 g protein; 1 egg or 1 ounce cheese=6 g protein; 1 cup legumes=15 g protein; cereals, grains, nuts and vegetables = 2 g protein per serving 0.85 (or 52 g/day of protein) 0.80 (or 56 g/day of protein) 14-18 yr (RDA) 19-30 yr (RDA) 1.5 7-15 yr 0.95 (or 34 g/day of protein) 9-13 yr (RDA) 2 3-6 yr 0.95 (or 19 g/day of protein) 4-8 yr (RDA) 2.5 1-2 yr 1.05 (or 13 g/day of protein) 1-3 yr (RDA) 3 6-11 mo 1.2 (or 11 g/day of protein) 7-12 mo (RDA) 3.5 0-5 mo 1.52 0-6 mo (AI) 1978 FNRI Publications, Daily Requirements of Filipinos (g/kg BW/day) 2005 Dietary Reference Intakes, U. S. Food and Nutrition Board, National Academy of Sciences (g/kg BW/day)
  20. 23. Amino Acids <ul><li>24 amino acids identified </li></ul>
  21. 24. Dietary Reference Intakes of Essential Amino Acids 32 7 27 25 51 56 28 46 1-3 yr 42 10 36 32 66 71 36 61 7-12 mo 77 25 65 52 95 139 78 120 0-6 mo 4-8 yr Amino Acid (mg/kg/24 hr) 22 Threonine 27 Valine 6 Tryptophan 21 Sulfur amino acids 43 Lysine 47 Leucine 25 Isoleucine 38 Aromatic amino acids
  22. 25. Evaluating Protein Quality <ul><li>Protein Efficiency Ratio (PER) </li></ul><ul><ul><li>Wt gained/gm protein consumed </li></ul></ul><ul><ul><li>U. S. FDA used PER as basis on food labels but PER based on amino acid requirements of growing rats </li></ul></ul><ul><li>Biologic Value (BV) of protein </li></ul><ul><ul><li>Amount of nitrogen accumulated compared with nitrogen absorbed </li></ul></ul><ul><ul><li>Indicates effectiveness of utilization but does not account for certain factors influencing digestion </li></ul></ul><ul><li>Net Protein Utilization (NPU) </li></ul><ul><ul><li>Percentage of nitrogen consumed that is retained by the body </li></ul></ul><ul><ul><li>Influenced by factors other than inherent composition such as reduced digestibility due to overheating lowering protein value by decreasing availability of essential amino acids </li></ul></ul>
  23. 26. Evaluating Protein Quality <ul><li>Amino Acid Score (AAS) </li></ul><ul><ul><li>A chemical technique measuring indispensable amino acids in a protein and comparing values with a reference protein </li></ul></ul><ul><ul><li>Fast, consistent and inexpensive </li></ul></ul><ul><li>Protein Digestibility Corrected Amino Acid Score (PDCAAS ) </li></ul><ul><ul><li>The currently accepted measure </li></ul></ul><ul><ul><li>Advantages: (1) Based on the amino acid requirements of humans (2) AAS plus digestibility component </li></ul></ul><ul><ul><li>Limitations: (1) Takes no account of where the proteins have been digested (2) Incomplete since human diets almost never contain only one kind of protein </li></ul></ul>
  24. 27. Fats’ Functions <ul><li>A concentrated & reserve source of energy </li></ul><ul><li>Physical protection for vessels, nerves, organs </li></ul><ul><li>Insulation against changes in temperature </li></ul><ul><li>Supply essential fatty acids: linoleic &  -linolenic acids </li></ul><ul><li>Structure of body tissues & cell membranes & nuclei </li></ul><ul><ul><li>Long-chain polyunsaturated fatty acids (LC-PUFA) especially arachidonic acid (ARA) and docosahexanoic acid (DHA) most prevalent in brain and photoreceptor membranes </li></ul></ul><ul><li>Carry the fat-soluble vitamins (A, D, E & K) </li></ul><ul><li>Give appetite appeal </li></ul><ul><li>Aid satiety (delay emptying time of stomach) </li></ul><ul><li>Spare protein </li></ul>
  25. 29. Essential Fatty Acids (EFAs) <ul><li>Linoleic acid (LA) and  -linolenic acid (ALA) </li></ul><ul><li>Necessary for growth, skin & hair integrity, cholesterol metabolism, lipotropic activity, decreased platelet adhesiveness and reproduction </li></ul><ul><li>Diets with <1-2% kcal of EFAs slow down growth rate, cause intertrigo or scaly rash and poor wound healing </li></ul><ul><li>The right ratio of LA to ALA in the diet 3:1 or 2:1 important since an imbalance may lead to a variety of mental disorders including hyperactivity, depression, brain allergies and schizophrenia </li></ul><ul><li>LA is abundant in soy oil, sesame seeds, corn oil, and most nuts while ALA is abundant in flax, small quantities in walnuts, canola oil, wheat germ and dark green leafy vegetables </li></ul>
  26. 30. Omega-3 and Omega-6 Fats <ul><li>LC-PUFA: >18 carbons in length with > 2 cis double bonds </li></ul><ul><li>Most relevant to infant nutrition: ARA (20:4n-6) and DHA (22:6n-3) </li></ul><ul><li>Infants can convert LA (18:2n-6) and ALA (18:3n-3) to ARA and DHA , respectively </li></ul><ul><li>ARA and DHA most prevalent in CNS suggesting importance to CNS function so that brain depletion can result in learning deficits </li></ul><ul><li>DHA about 40% of retinal photoreceptor membrane fatty acids, hence, important for visual and neurological development </li></ul><ul><li>However, variable research data as to advantages of LC-PUFA–supplemented formulas* so that there is no recommendation yet with regards to LC-PUFA supplementation </li></ul>
  27. 31. <ul><li>Eicosanoids derived from DGLA , ARA and EPA have critical roles in immune and inflammatory responses by being formed into prostaglandins and leukotrienes </li></ul><ul><li>EPA eicosanoids less potent inducers of inflammation, blood vessel constriction, and coagulation than from ARA </li></ul>
  28. 32. <ul><li>When levels of omega-6 ARA, found in most oils and meat, high in brains of rats, they showed signs of depression </li></ul><ul><li>According to Depression and Bipolar Support Alliance, depression most common serious brain disease in U. S., affecting more than 23 million adults each year </li></ul><ul><li>Previous studies revealed decreased omega-3 fatty acid intake could be responsible </li></ul><ul><li>The omega-6 LA comprises 7% to 9% of an American daily caloric intake while omega-3 ALA makes up only 0.7%, thus, LA to ALA ratio 10-20:1, far more than recommended 2-3:1 and at which level ALA metabolism suppressed </li></ul><ul><li>Recent studies show that depression may be controlled by shifting balance -- cutting on omega-6 and increasing omega-3 to bring to right ratio </li></ul>
  29. 33. REQUIREMENT vs RECOMMENDED INTAKE vs REFERENCE INTAKE <ul><li>Estimated average requirement (EAR) </li></ul><ul><li>Recommended daily allowance (RDA) </li></ul><ul><li>Dietary reference intakes (DRIs) </li></ul><ul><ul><li>Adequate intake (AI) </li></ul></ul><ul><ul><li>Tolerable upper intake (UL) </li></ul></ul><ul><li>Estimated energy requirement (EER) </li></ul>
  30. 34. Estimated Average Requirement <ul><li>Amount of a nutrient that results in some predetermined physiologic end-point* </li></ul><ul><li>Usually defined experimentally, often over relatively short period and in relatively small study population </li></ul><ul><li>Daily intake value estimated to meet the needs of half the healthy individuals or population in which it was established </li></ul><ul><li>Used to calculate the RDA, to assess adequacy of group intakes and to plan intake of groups </li></ul>
  31. 35. Recommended Dietary Allowance <ul><li>Average daily nutrient intake level sufficient to meet the nutrient requirement of most healthy members (97-98%) of a population </li></ul><ul><li>Set at the mean requirement (EAR) and normally distributed plus 2 standard deviations </li></ul><ul><li>Used as goal for daily intake by individuals since estimates an intake level that has a high probability of meeting the requirement of a randomly chosen individual (about 97.5%) </li></ul>
  32. 36. Dietary Reference Intakes <ul><li>Recommendations in the 2005 U.S. Food and Nutrition Board, National Academy of Sciences Report </li></ul><ul><li>Include RDAs with EAR as well as AI and UL </li></ul><ul><li>AI: Estimates of observed median daily nutrient intakes by a group (or groups) of apparently healthy people </li></ul><ul><ul><li>Used when an RDA cannot be established but not same </li></ul></ul><ul><ul><li>Set at the amount in average volume of milk consumed by healthy, normally growing breast-fed infants 0-6 mo </li></ul></ul><ul><ul><li>Set at the amount in average volume of human milk plus average amount of complementary foods by healthy, normally growing 7-12 mo old infants </li></ul></ul><ul><li>UL: Highest daily intake of a nutrient likely to pose no risk </li></ul><ul><ul><li>An aid for avoiding excessive intake and adverse effects </li></ul></ul>
  33. 38. DRIs vs Former RDAs & RNIs <ul><li>Main uses same: diet assessment and diet planning </li></ul><ul><li>Differences of DRIs from U.S. former RDAs and Canada’s recommended nutrient intakes (RNIs): </li></ul><ul><ul><li>Reduction in risk of chronic degenerative disease included in formulation rather than just absence of signs of deficiency </li></ul></ul><ul><ul><li>UL established where data regarding risk of adverse health effects exist </li></ul></ul><ul><ul><li>Components of food that may not meet traditional concept of nutrient but of possible benefit to health reviewed and when enough data exist, reference intakes established </li></ul></ul>
  34. 39. Estimated Energy Requirement <ul><li>Daily requirement for energy as defined by the DRIs predicted to maintain energy balance in a healthy individual of a defined age, sex, weight, height (length) and level of physical activity </li></ul><ul><li>Based on calculations that account for an individual’s age, sex, weight, height, energy intake, energy expenditure measured by doubly labeled water method plus an allowance for energy deposition and physical activity level </li></ul><ul><li>The motivation for EER tied to public health awareness and concern about increased prevalence of overweight and obesity in North America and the need to adequately assess energy balance </li></ul><ul><li>Expressed per unit of body weight, EER of normal infant about twice of normal adult </li></ul>
  35. 40. Equations to Estimate Energy Requirement 354 - (6.91 x age [y]) + PA x (9.36 x weight [kg]) + (726 x height [m]) Female 662 - (9.53 x age [y]) + PA x (15.91 x weight [kg]) + (539.6 x height [m]) Male Ages 19 years and older EER (kcal/day) = TEE 135.3 - (30.8 x age [y]) + PA x (10 x weight [kg])+ (934 x height [m]) + 25 kcal 9-18 yr 135.3 - (30.8 x age [y]) + PA x (10 x weight [kg])+ (934 x height [m]) + 20 kcal 3-8 yr Female 3-18 years EER = TEE + energy deposition 88.5 - (61.9 x age [y]) + PA x (26.7 x weight [kg]) + (903 x height [m]) + 25 kcal 9-18 yr 88.5 - (61.9 x age [y])+ PA x (26.7 x weight [kg]) + (903 x height [m]) + 20 kcal 3-8 yr Male 3-18 years EER = TEE + energy deposition (89 x weight [kg] - 100) + 20 kcal 13-36 mo (89 x weight [kg] - 100) + 22 kcal 7-12 mo (89 x weight [kg] - 100) + 56 kcal 4-6 mo (89 x weight [kg] - 100) + 175 kcal 0-3 mo Ages 0-36 months EER (kcal/day) = TEE + energy deposition
  36. 41. Water <ul><li>Essential for life </li></ul><ul><li>Normal infant absolute requirement probably 75-100 ml/kg/24 hr </li></ul><ul><li>Of fluid intake: water retained 0.5-3%, evaporated from lungs & skin 40-50%, fecal losses 3-10% & renal excretion > 40-50% </li></ul><ul><li>Daily consumption: 10-15% BW healthy infant versus 2-4% BW in adult </li></ul>
  37. 43. Minerals <ul><li>Macrominerals </li></ul><ul><li>Sodium 1gm or 2mEq/kg </li></ul><ul><li>Potassium 1-2gm or 1.5mEq/kg </li></ul><ul><li>Calcium 0.6gm/day </li></ul><ul><li>Magnesium </li></ul><ul><li>150-300mg/day </li></ul><ul><li>Chlorine 0.5gm/day </li></ul><ul><li>Phosphorus </li></ul><ul><li>Sulfur 0.5-1gm/day </li></ul><ul><li>Microminerals </li></ul><ul><li>Iron 1mg/kg/day </li></ul><ul><li>Iodine 34-45 mcg/day </li></ul><ul><li>Copper 0.5-1mg/kg/day </li></ul><ul><li>Fluorine 0.5-1mg/day </li></ul><ul><li>Zinc 3-5mg/kg/day </li></ul><ul><li>Cobalt 1-2mcg/day </li></ul><ul><li>Manganese </li></ul><ul><li>0.05-1.5mg/day </li></ul><ul><li>Chromium </li></ul><ul><li>0.02-0.10mg/day </li></ul><ul><li>Selenium </li></ul><ul><li>0.02-0.10mg/day </li></ul><ul><li>Molybdenum </li></ul><ul><li>0.05-0.15mg/day </li></ul>
  38. 44. Macrominerals <ul><li>Sodium, Chloride, Potassium work together to regulate the flow of fluids in the body & help regulate the nervous system, muscle functions & nutrient absorption in the cells </li></ul><ul><li>Calcium is needed for bone rigidity, blood clotting, muscle contraction & normal nerve functions </li></ul><ul><li>Phosphorous aids in all phases of calcium metabolism & helps build strong bones & teeth </li></ul><ul><li>Magnesium helps regulate body temperature, muscle contractions, the nervous system & helps cells utilize carbohydrates, fats, and proteins </li></ul><ul><li>Sulfur helps in detoxification reactions, present in amino acids in proteins & a component of mucopolysaccharides & essential compounds </li></ul>
  39. 45. Microminerals <ul><li>Iron combines with protein to form hemoglobin </li></ul><ul><li>Iodine needed by thyroid gland for thyroxine </li></ul><ul><li>Copper necessary in the formation of hemoglobin </li></ul><ul><li>Fluorine helps reduce incidence of tooth decay </li></ul><ul><li>Zinc important in the formation of protein, thus, assists in wound healing, blood formation and general growth & maintenance of all tissues </li></ul><ul><li>Manganese necessary for normal development of bones and connective tissues </li></ul><ul><li>Chromium maintains normal glucose uptake into cells & helps insulin bind to cells </li></ul><ul><li>Selenium w/vitamin E protect cells from destruction </li></ul><ul><li>Molybdenum, a component of xanthine oxidase and aldehyde oxidase </li></ul>
  40. 47. Vitamins <ul><li>Organic compounds in minute amounts that catalyze cellular metabolism </li></ul><ul><li>Cannot be biosynthesized by our bodies so must be supplied by the diet or taken as supplements </li></ul><ul><li>To date, there are 13 essential vitamins as included in the 2005 DRIs by the U.S. Food and Nutrition Board, National Academy of Sciences </li></ul><ul><li>Classified as </li></ul><ul><ul><li>Water-soluble: Thiamin (B1), Riboflavin (B2), Niacin (B3), Pantothenic acid (B5), Pyridoxine (B6), Biotin (B7) Folacin (B9), Cobalamin (B12) and Ascorbic acid (C) </li></ul></ul><ul><ul><li>Fat-soluble: Retinol (A), Cholecalciferol (D), Tocopherol (E) and Vitamin K </li></ul></ul>
  41. 49. ASSESSMENT OF NUTRITIONAL STATUS OF CHILDREN <ul><li>History </li></ul><ul><li>Dietary history of mother & child </li></ul><ul><li>History of height & weight changes </li></ul><ul><li>Anthropometric indicators </li></ul><ul><li>Evidence of deviations from average height & weight </li></ul><ul><li>Evidence of depletion of fat depots </li></ul><ul><li>Evidence of decrease in muscle mass </li></ul><ul><li>Change in psychic reaction </li></ul><ul><li>Reaction to infection </li></ul><ul><li>Evidence of specific deficiencies </li></ul>
  42. 50. ANTHROPOMETRIC INDICATORS OF NUTRITIONAL STATUS <ul><li>Weight (Wt): index of acute nutritional status </li></ul><ul><li>Height (Ht) or Length (Lt): assesses growth failure; unaffected by excess fat or fluid </li></ul><ul><li>Weight-for-Height: assesses body build more accurately </li></ul><ul><ul><li>Measure child’s height </li></ul></ul><ul><ul><li>Find age for which measured height is on the 50 th % on the growth curve </li></ul></ul><ul><ul><li>Child’s actual weight (numerator) </li></ul></ul><ul><li>50 th % wt based on age of plotted ht (denominator) </li></ul>
  43. 51. A 6-yr-old boy has an actual weight of 15 kg & height of 105 cm. Compute for the wt-for-ht%. Actual Wt = 15 kg Actual Ht = 105 cm IBW based on actual age (6 yr) = 20 kg IBW based on plotted Ht = 17 kg Wt-for-Ht% = 15/ 17 = 0.88 Wt-for-age% = 15/ 20 = 0.75 Ht-for-age% = 105 / 110 = 0.95
  44. 52. <ul><li>Head circumference (HC): influenced by nutrition till age 36 mo; <5 th % measurements may mean chronic undernutrition fetal life & early childhood </li></ul><ul><li>Thickness skinfold (TSF): estimates total body fat </li></ul><ul><li>Mid-arm circumference (MAC)/Mid-arm muscle circumference (MAMC): with TSF, determines muscle area & fat area </li></ul><ul><ul><li>MAMC = MAC – (3.4 x TSF) </li></ul></ul><ul><li>Bone age: epiphyseal closure as determined from x-rays; percentage of maturity attained indicates potential for catch-up growth; hand & the wrist useful at all ages; also leg in early infancy </li></ul>
  45. 53. <ul><li>Growth Velocity (GV) </li></ul><ul><li>Evaluates change in rate of growth </li></ul><ul><li>More sensitive way of assessing growth failure or slowed growth </li></ul><ul><li>Formula: </li></ul><ul><li>GV(cm) = H 2 (cm) – H 1 (cm) </li></ul><ul><li> T(yr) </li></ul><ul><li>where </li></ul><ul><li>H 1 = initial height in centimeters </li></ul><ul><li>H 2 = height at next measurement </li></ul><ul><li>T = period between two </li></ul><ul><li> measurements in years </li></ul>
  46. 54. <ul><li>Body Mass Index (BMI)-for-Age </li></ul><ul><li>An effective screening tool specific for age and gender but not a diagnostic tool </li></ul><ul><li>Formula: Weight(kg)/Height(m 2 ) </li></ul><ul><li>BMI-for-age cut-offs </li></ul><ul><li>> 95 th % Overweight </li></ul><ul><li>85 th - <95 th % Risk of overweight </li></ul><ul><li><5 th % Underweight </li></ul><ul><li>BMI-for-age correlates w/ clinical </li></ul><ul><li>risk factors in CVS disease such as </li></ul><ul><li>hyperlipidemia, elevated insulin & </li></ul><ul><li>high blood pressure during middle age </li></ul>
  47. 55. Can you see risk? Age = 3 y 3 wks boy Height = 100.8 cm Weight = 18.6 kg Age = 4 y girl Height = 99.2 cm Weight = 17.55 kg Age = 4 y 4 wks girl Height = 106.4 cm Weight = 15.7 kg C BMI=18.3 = >95 th % Overweight A BMI=13.9 = 10 th % Normal B BMI=17.8 = 90 th –95 th % At risk for overweight
  48. 56. BMI-for-Age C A B
  49. 57. RELAX !!!
  50. 58. It is easier for a camel to pass through the eye of a needle if it is lightly greased. Kehlog Albran THANK YOU!

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