Nutrition Through Life Cycle Unit 3
Early thelarche is more common among overweight and obese girls suggesting that variations in body weight and composition may play a role in the onset of puberty.
*Early thelarche: 早発乳房発育
The SHI (School Health Index) helps:
Identify strengths and weaknesses in health promotion policies and strategies Develop an action plan Involve stakeholders (teachers, parents, students, community) in improving school policies and programs
Supplements not needed for children who eat a varied diet & get ample physical activity
If supplements are given, do not exceed the Tolerable Upper Intake levels
What Healthy People 2020 objective related to school-age children has a target of 100%? (P. 307)
Increase the proportion of children and adolescents aged 6 to 14 years who use a computer or play computer games outside of school for no more than 2 hours a day.
Lower calories needed by children with slow growth or decreased muscles such as in Prader-Willi syndrome
Increased calories needed as activity increases such as in ADHD or ASD
Folate added to fortified foods is better absorbed than folate from natural foods
Increased risk of folate deficiency Skipping breakfast, no fortified foods
Iron deficiency Determined by low serum iron, plasma ferritin & transferrin saturation Iron deficiency more frequent Often undiagnosed because of expense
Iron-deficiency anemia Determined by simple and inexpensive hemoglobin or hematocrit levels Indicates more advanced stage of iron deficiency Less frequent but almost exclusively females
Peak velocity of linear growth occurs during SMR 4 & ends with appearance of facial hair at ~age 14.4
Linear growth continues throughout adolescence ceasing at ~age 21
Anabolic-androgenic Steroids
Linked to infertility, hypertension, physeal closure, depression, aggression, & increased risk of atherosclerosis ２ commonly used steroids that are precursors of testosterone & estrogen are: ・Androstenedione (Andro)— controlled substance ・DHEA (Dehydroepiandrosterone) widely available as supplements
Gastrostomy feeding may be required for:
-Kidney disease -Some cancers -Severe cerebral palsy -Cystic fibrosis
The estimated protein need for adolescents is _____g/kg body weight/day, which is _______ for adults.
0.85; slightly higher than
Based on DRIs, the recommended protein intake for school-age children is ____ gram(s) of protein per kg of body weight per day for 4 to 13-year-olds.
0.95 g
It is recommended that children engage in at least _____ of physical activity every day and no more than ____ of screen time each day.
1 hour; 2 hours
The National School Lunch Program (NSLP) Standards:
1. Both fruits and vegetables every day; increasing whole grains 2. Only fat-free or low fat milk 3. Limiting calories based on child' age 4. Reduce saturated and trans fats, and sodium
On average, what proportion of a teen's daily energy intake is supplied by eating snacks between meals?
1/4
Most define a chronic condition in a child as one expected to last ____ or more.
12 months
What is the RDA for calcium for children 9-13 years of age?
1300 mg
During early childhood years, body fat reaches a minimum of ____ percent in females and ____ percent in males.
16; 13
Research suggests that a level of ____ percent body fat is required for menarche to occur. *Menarche:初潮
17 %
Growth velocity will slow down during the school-age years
2000 CDC growth charts Tools to monitor the growth of a child for the following parameters Weight-for-age Stature-for-age Body mass index (BMI)-for-age Based on data from cycles 2 & 3 of the National Health & Examination Survey (NHES) & the National Health & Nutrition Examination Surveys (NHANES) I, II, & III
Children with special health care needs are found to use complementary and alternative medicine at a higher rate, ____ percent, than healthy children.
30-70 %
An estimated ____ of children and adolescents aged 2 to 19 years are either overweight or obese.
34%
The accrual of bone mass during adolescence is significant as young adolescents have been found to retain up to ____ times as much calcium as young adults.
4
Energy needs vary by activity level & body size The protein DRI is 0.95 g/kg body wt Intakes of vitamins & minerals appear adequate for most U.S. children
4-8 years iron 10mg/d Zinc 5mg/d Calcium 1000mg/d 9-13 years iron 8mg/d Zinc 8mg/d Calcium 1300mg/d
Jamie weighed 165 pounds before his workout and weighed 162 pounds after his workout. How much fluid should Jamie consume after his workout to maintain proper hydration?
48 ounces
Competitive athletes may require an additional ______ calories per day to meet their energy needs.
500-1500 kcal
Youth with BMI values between the ______ percentile are considered overweight, while youth with BMI values above the _____ percentile are considered obese.
85th — 94th ; 95th
Dietary Recommendations to Reduce Hyperlipidemia
<35% calories from total fat <10% calories from saturated fat Cholesterol intake ≤300 mg/day Adequate fruits, vegetables, grains, & low-fat dairy
To be considered as a candidate for bariatric surgery, adolescents must have a BMI of _____ with medical major complications or a BMI of ____ with minor co-morbidities.
>35; >40
70% of children with developmental delays have feeding difficulties
Eating and feeding problems are diagnosed when children have difficulty with: -Accepting foods -Chewing them safely -Ingesting enough foods and beverages
Vitamin D Requirements
Essential role in facilitating intestinal absorption of calcium and phosphorus Synthesized by the body via skin exposure of ultraviolet B rays of sunlight In northern latitudes, may require supplementation RDA - 600 IU/day
Data from NHANES I, II, & III suggest weight gain linked to inactivity rather than increases in energy intake
Excessive body weight increases risk of cardiovascular disease & type 2 diabetes mellitus
Growth Assessment & Interpretation in Children with Chronic Conditions
Factors that affect growth: -Age of condition onset ・May determine if growth charts will be applicable -Secondary conditions ・May interfere with accurate measurements -Activity/inactivity level
Teens below the 10th percentile of weight-for-height or BMI-for-age are considered to be underweight and should be referred for evaluation of metabolic disorders, chronic health conditions, or eating disorders.
False
Risk Factors for Hypertension
Family history of hypertension High sodium intake Overweight Hyperlipidemia Inactive lifestyle Tobacco use
Carbohydrates: 130 g/day or 45-65% of calories Dietary Fiber: DRI recommends 26 g/day for adolescent females 31 g/day for males <14 years of age 38 g/day for older adolescent males
Fat: Required as dietary fat and essential fatty acids for growth and development 25-35% of calories from total fat <10% calories from saturated fat
Financial assistance provided by the federal gov't to schools participating in the National School Lunch Program
Five requirements 1 Lunches based on nutrition standards 2 No discrimination between those who can and cannot pay 3 Operate on a non-profit basis 4 Programs must be accountable 5 Must participate in commodity program
Dietary Recommendations for Adolescent Athletes
Follow MyPlate guidelines -May need upper limit of food group servings because of increased energy needs -Eat pre-event meal at least 2-3 hours prior to exercise -Post-event meals should contain 400-600 calories & be high in complex carbs & adequate non-caffeinated fluids ・Avoid foods high in fat, protein & dietary fiber for at least 4 hours before event
Cross-cultural Considerations
Healthy People 2020-a major goal-eliminate health disparities among different segments of the population Health care professionals should learn about cultural dietary practices
Current data suggests that dieting is most common among ________, who also have the highest reported rates of vomiting and use of laxatives to lose weight.
Hispanic females
For children older than 3 years of age, the educational planning document used is the ________.
IEP: Individualized education plan
Children with special health care needs vary in nutritional requirements & health needs:
Low energy intake with small muscle size High protein, fluid or fiber Increases or decreases in vitamins or minerals Frequent hospitalizations
U.S. adolescents have inadequate intake of vitamins & minerals including: Folate Vitamins A, B6, C, & E Iron & zinc Magnesium Phosphorus & calcium Dietary fiber
Many adolescents have diets that do not match the Dietary Guidelines for Americans or the MyPlate Recommendations Most have inadequate consumption of: Dairy Grains Fruits and Vegetables 32% of calories from fat & 21% from added sugars
Attention Deficit Hyperactivity Disorder (ADHD) →Most common neurobehavioral problem (~5% to 8% of children) Chaotic meals & snacks with difficulty staying seated May be given fewer opportunities in the kitchen due to impulsiveness
Medications: ・May decrease appetite & growth ・Medication peak activity is aimed at school hours Appetite returns to normal when meds are not given such as on weekends & school holidays ・No evidence of nutrition as a cause and treatment but families may choose herbal medicines anyway
DRIs provide the best estimate of nutrient requirements for adolescents
Nutrient recommendations based on chronological rather than biological development
More than half of U.S. adolescents report playing one or more sports 62% of males 50% of females
Nutrition concerns include: -Fluid & hydration -Carbohydrate loading -High-protein diets
The two most commonly performed surgical weight loss procedures for adolescents in the U.S. are the adjustable gastric band and the Roux-en-Y gastric bypass.
True
U.S. education laws specify that by 8 years of age, stricter classifications of disability become the basis for educational services eligibility.
True
While the sequence of events during puberty is consistent among adolescents, the age of onset, duration, and tempo of these events may vary a great deal between and within individuals.
True 思春期に経験する発達は同じだが、時期は個人によって異なる
Commodity Program
USDA program in which food products are sent to schools for use in the child nutrition programs. Commodities are usually acc¥quired for farm proce support and surplus-removal reasons.
Seizures
Uncontrolled electrical disturbances in brain Seizures = Epilepsy (癲癇:てんかん） Results of a seizure range from mild blinking to severe jerking Postictal state—time after seizure of altered consciousness ーーーーーーーーーーーー Treatment: Feeding or eating during postictal state not recommended due to chocking risk Medications—may impact growth and/or appetite Ketogenic diets—severely low-CHO diet with increased calories from fat
For heart health, children (4 to 18 years of age) should receive at least ____ and no more than ____ of total energy from fat.
b. 25%; 35%
What dietary pattern is a key indicator of nutrition risk for adolescents?
consumes a vegetarian diet
Which nutrient is LEAST likely to play a role in bone health?
copper
What nutritional supplement is marketed as a means to increase lean body mass and has dose-related side effects of cramping, nausea, diarrhea, headache, and reduced renal function(腎機能) ?
creatine
What is a side effect of psychostimulant medications that causes nutritional concern?
decreased appetite
Special diets among adolescent athletes include high-protein diets, which places them at an increased risk for ________.
dehydration
What dietary assessment method used in clinical settings is appropriate for most people because it can be accomplished in a single interview?
diet history
Cognitively, _________ is a time dominated by concrete thinking, egocentrism, and impulsive behavior.
early adolescence
One example of a social factor associated with increased physical activity among adolescents is ______.
family affluence
Which child is most likely to watch more than 2 hours of television per day?
family income is at "低い" % of the federal poverty level.
According to food consumption surveys, children are not eating the recommended amount of _____ in their diets, but they are exceeding the recommendations of total calories from _______.
fiber; saturated fat
The "CDC Growth Charts: United States" are the recommended tool for monitoring the growth of a child.
he appropriate growth charts are gender-specific for children 2-20 years of age, and allow the user to plot weight-for-age, stature-for-age, and body mass index (BMI)-for-age. They can be downloaded from the CDC website
One of the last serum indicators of iron-deficiency anemia is ______.
hemoglobin level
Which statement about children who regularly skip breakfast is true?
hey are likely to have difficulty concentrating in school.
Early BMI rebound
higher BMIs in children later
According to the USDA, which item(s) would be considered a competitive food?
ice cream sold during lunch time in the cafeteria
Of the following blood lipid readings, which one would indicate hyperlipidemia in an adolescent?
triglycerides at 165 mg/dL
In general, the adolescent growth spurt begins at age 10 to 11 for females and at 12 to 13 for males.
true
Adolescents who use tobacco have been shown to have higher ______ requirements while adolescents who frequently consume large quantities of alcohol have higher ______ requirements.
vitamin C; thiamin
Reasons adolescents are at risk for dehydration:
ーYoung adolescents do not regulate body temperatures well ーIgnore physiological signs of fluid loss ーMay be unaware of need for fluids
Postictal state
発作後状態
Effects of iron deficiency on adolescents:
-Delayed or impaired growth & development -Fatigue -Increased susceptibility to infection -Depressed immune system -Impaired physical performance & endurance -Increased susceptibility to lead poisoning
Health conditions may alter muscle size, bone structure, fat stores
-Down syndrome results in short stature, low muscle tone, & low weight -Cerebral palsy & spina bifida may reduce muscle tone -Spina bifida may impact muscles only in the lower extremities
Treatment of Iron- Deficiency Anemia
-Increase intake of foods rich in iron & vitamin C -Iron supplements Under age 12 —60 mg/day Over age 12 —60 (males) to 120 (females) mg/day
High-protein diets
-May consist of 3-4 times the DRI "Should be discouraged because:" -Protein foods typically high in total & saturated fats -Protein & fat may delay digestion & absorption, limiting total energy available for activity More water required for protein breakdown which increases dehydration risk
Cystic fibrosis
-One of most common lethal genetic conditions -Interferes with lung function -Causes decreased absorption nutrients -Malabsorption due to lack of pancreatic enzymes ----------------------- -Calories & protein increase 2 to 4 fold -Enzymes taken with meals to aid in digestion -Frequent meals & snacks -Fat-soluble vitamin supplements -Gastrostomy feeding at night may be needed to boost energy intake
Changes in Weight, Body Composition, and Skeletal Muscles in Females
-Peak weight gain follows linear growth spurt by 3 to 6 months Gain of ~18.3 pounds per year -Average lean body mass decreases 44% increase in lean body mass (LBM) 120% increase in body fat -17% body fat is required for menarche to occur -25% body fat needed to maintain normal menstrual cycles
Changes in Weight, Body Composition, and Skeletal Muscles in Males
-Peak wt gain at the same time as peak linear growth & peak muscle mass accumulation -Peak wt gain, ~20 lb per year -Body fat decreases to ~12% ~Half of bone mass is accrued in adolescence
Use of substances can affect nutritional status
-Tobacco increases Vitamin C needs -Alcohol replaces nutritious foods and beverages -Illicit drugs may increase risk for disordered eating behaviors
Conditions that impact fluid status and increase needs include:
-Uncontrollable drooling -Constipation from neuromuscular disorders -Multiple medication use
whic Child requires an interpretation of growth modified from the ususal CDC growth chart intepretation?
A child with mild cerebral palsy with scoliosis
In 2010, 7.3 million U.S. children younger than 18 years of age (representing 9.8 percent of the population) did not have health insurance
A similar percentage of children, 9.3 percent, did not see a physician or other health care professional in the previous year for sick or well care.
School Breakfast Program
Authorized in 1966 ・States may require schools who serve needy populations to provide school breakfast ・The NSLP rules apply to the School Breakfast Program ・Breakfast must provide ¼ the DRI
Nutrition and Prevention of CVD in School-Age Children
Acceptable range for fat is 25% to 35% of energy for ages 4 to 18 year Include sources of linoleic (omega-6) and alpha-linolenic (omega-3) fatty acids Limit saturated fats, cholesterol & trans fats
In early childhood, body fat reaches a minimum then increases in preparation for adolescent growth spurt
Adiposity rebounds between ages 6 to 6.3 years
Nutrition Integrity in Schools
All foods available in schools should be consistent with the U.S. Dietary Guidelines & Dietary Reference Intakes Sound nutrition policies need community & school environment support Community leaders should support the school's nutrition policy The School Health Index (SHI) should be completed & implemented
Currently, type 2 diabetes is most prevalent in _______ youth.
American Indian
What program or law ensures that school cafeteria lines accommodate wheelchairs?
Americans with Disabilities Act
Binge-eating disorder → Characterized by periodic binge eating not followed by vomiting or use of laxatives
Anorexia nervosa →Characterized by extreme wt loss, poor body image, & irrational fears of wt gain & obesity Bulimia nervosa →Characterized by recurrent episodes of rapid uncontrolled eating of large amounts of food in a short period of time frequently followed by purging
Tertiary care intervention ーTreatments may include： ・Meal replacement ・A very low energy diet ・Medication ・Surgery may be implemented
Appropriate with severely obese youth or those who have significant, chronic co-morbidity conditions Level of treatment provided through a tertiary wt management center Diet and activity counseling with behavior modifications
Compared to normal weight peers, overweight children
Are taller Have advanced bone ages Experience earlier sexual maturity Look older Are at higher risk for obesity-related chronic diseases
The best time to screen for hyperlipidemia is around age 10 or after age 17 because total and LDL cholesterol levels drop by 10-20 percent during puberty.
True
Public Food and Nutrition Programs ：Child nutrition programs
Began in 1946 Provide nutritious meals to all children Reinforce nutrition education Require schools to develop a wellness policy
During periods of slower growth, the child's appetite and intake will decrease. Parents should not be overly concerned with this variability in appetite and intake in their school-age children.
Both weight and height should be plotted on the appropriate 2000 CDC growth charts.
An early BMI rebound has been associated with an increase risk of overweight and obesity.
Boys may become concerned about developing muscle mass and need to understand that they will not be able to increase their muscle mass until middle adolescence
The Whole School, Whole Community, Whole Child model developed by the ______ expanded the Coordinated School Health approach.
CDC
n most clinical settings in the United States, the ______ are used to monitor the growth of children.
CDC Growth Charts
~4 times more calcium retained during early adolescence compared to early adulthood (Adolescents who do not include dairy should consume calcium-fortified foods) Soft drink consumption displaces nutrient-dense beverages such as milk & fortified juices
Calcium DRI for ages 9-18 years is 1300 mg/d but, Average intake is: 948 mg for females 1260 mg for males Weight-bearing activities may lead in increased bone mineral density
Iron Iron-rich foods: meats, fortified breakfast cereals, dry beans, & peas Fiber Increase fresh fruits and vegetables, whole grain breads, and cereals Fat Decrease saturated fat and trans fatty acids
Calcium & Vitamin D If lactose intolerant: Do not completely eliminate dairy products but decrease only to point of tolerance
Calcium absorption rate in females is highest around menarche
Calcium absorption rate in males highest during early adolescence
the growth charts are based on data from the second and third cycles of the National Health and Examination Survey (NHES) and the National Health and Nutrition Examination Surveys (NHANES) I, II, and III. However, weight data for children greater than 6 years of age who participated in NHANES III were not included because there was a known higher prevalence of overweight for these ages.
Children whose BMI-for-age is greater than or equal to the 85th percentile but less than or equal to the 94th percentile are classified as overweight, while children whose BMI-for-age is greater than or equal to the 95th percentile are classified as obese
Side Effects of Iron Supplements
Common side effects include constipation , nausea, cramps -Reduce side effects by ・Taking small, frequent doses ・Take with meals Factors ⇓ iron absorption include -Calcium supplements -Dairy products -Coffee, Tea -High-fiber foods
About 18% of children & adolescents have a chronic condition or disability
Condition may put person at risk for nutrition problems related to: Altered consumption, digestion or absorption Biochemical imbalances Psychological stress Environmental factors
Growth charts are available for some special conditions (p.337)
Conditions that do not have growth charts include: -Juvenile rheumatoid arthritis Cystic fibrosis Rett syndrome Spina bifida Seizures Diabetes
Supplements may be beneficial for conditions to assure adequate intake
Conditions that require supplements: -Chewing problems need liquid supplements -Diabetes or on ketogenic diets should avoid supplements with added CHO -PKU should avoid supplements with certain artificial sweeteners -Cystic fibrosis requires fat-soluble vitamins -Galactosemia (restricts dairy) requires calcium
Pouring Right
Contracts b/w schools and soft-drink companies whereby the schools receive a percentage of the profits of soft-drink sales in exchange for the school offering only that soft-drink company's products on the schoo; campus.
Eating & Feeding Problems in Children with Special Health Care Needs-Specific Disorders
Cystic fibrosis Diabetes mellitus Seizures Cerebral palsy Phenylketonuria (PKU) Attention deficit hyperactivity disorder (ADHD) Pediatric HIV
The CDC developed the Whole School, Whole Community, Whole Child model to expand the Coordinated School Health approach.
True
Nutrition Counseling for Hypertension
Decrease sodium intake Limit fat to 30% of calories Consume adequate fruits, vegetables, whole grains, & low-fat dairy Weight loss if overweight Dietary recommendations should be encouraged even if meds are prescribed
Phenylketonuria (PKU） Body lacks enzyme needed to metabolize phenylalanine Require intervention to manage breakdown of dietary proteins
Diet is adequate in vitamins, minerals, pro, fat and calories Nutrients are often provided in liquid rather than solid form Dietary treatment includes avoiding meats, eggs, dairy products, nuts & soy beans
Diabetes Mellitus
Disorder in insulin & blood glucose regulation ・Type 1—virtually no insulin production ・Type 2—associated with obesity Treatment includes: -Timing & composition of meals & snacks -Insulin injections—for type 1 -Exercise -Summer camps for diabetic children
Three periods of psychosocial development
Early adolescence (11 to 14) Middle adolescence (15 to 17) Late adolescence (18 to 21)
Cerebral Palsy → Group of disorders resulting from brain damage with impaired muscle activity & coordination ・Spastic quadriplegia presents most nutritional problems
Nutrition concerns: Slow growth Difficulty feeding & eating Athetosis (less common form of CP)—uncontrolled movement which increases energy expenditure
Pediatric HIV
Nutrition is important for HIV management ・Antiretroviral therapy depresses appetite & food intake Other nutrition concerns: ・Control food-related infections ・Access to determine need for complete nutritional supplements ・Referrals to food banks Dietary approaches have to customized
Obese = BMI-for-age >95th% Overweight = BMI-for-age from 85th to 95th%
Obesity more common in Hispanic and non-Hispanic black children and adolescents Heaviest children are getting heavier
What chronic condition in children requires a reduced intake of protein?
PKU
Recovery from burns & cystic fibrosis increases protein needs to 150% DRI
PKU and other protein-based inborn errors of metabolism require decreased protein
Bariatric Surgery
Performed only if obesity has medical comorbidities BMI >35 with major complications or BMI >50 with minor complications
What chronic condition has a special growth chart used in conjunction with the CDC 2000 growth chart for assessment of growth and development?
Prater-Will syndrome
Middle childhood—between the ages of 5 and 10 years
Preadolescence —ages 9 to 11 years for girls; ages 10 to 12 years for boys may also be termed "school-age"
Competitive athletes may need 500-1500 additional calories per day Special concern for vegetarian athletes or restricted caloric intake to maintain a particular weight
Protein should supply no more than 30% of calories in the diet
Vegetarian Diets During Adolescence (About 4% of adolescents report following a vegetarian diet)
Reasons adolescents adopt a vegetarian diets include: -Cultural or religious beliefs -Moral or environmental concerns -Health beliefs -To restrict fat and/or calories -A means of independence from family
the innate ability of young children to internally control their energy intake and their responsiveness to energy density. The internal controls can be altered by external factors, such as child-feeding practices. Studies in 9- to 10-year-old children found that these older children were not as responsive to energy density as young preschool-age children were..
Recent research has emphasized the importance of parents assuming responsibility for providing a healthy food environment, but not being overly controlling or restrictive of their child's intake.
Comprehensive multidisciplinary intervention
Same behavioral goals as stage 2 More structured eating More structured physical activity plan Designed to lead to negative caloric balance
National Guidelines for Weight Management Therapy
Same behaviors as stage 1 More structured ーScreen time is limited to <1 hour per day ーEmphasize nutrient-dense foods ーMinimize energy-dense foods
What public food and nutrition program is required to provide one-fourth of the DRIs for children being served, based on age or grade group, and comply with the U.S. Dietary Guidelines for Americans when analyzed over a week's time?
School Breakfast Program
The AMA recommends all adolescents receive annual health screening & guidance
Screening should include: Wt, ht, & BMI Disordered eating tendencies Blood lipid levels Blood pressure Iron status (hemoglobin/hematocrit) Food security/insecurity Dietary intake/adequacy
Dental caries
Seen in half of children aged 6 to 9
Folate required for DNA, RNA & protein synthesis DRI: 400 mcg
Severe folate deficiency leads to megaloblastic anemia Severe deficiency rare but inadequate folate status appears to be more common
Puberty occurs during early adolescence
Sexual Maturation Rating (SMR) ("Tanner Stages")—scale of secondary sexual characteristics used to assess SMR 1=prepuburtal growth & development SMR 2-5=occurrences of puberty SMR 5= sexual maturation has concluded
Benefit of growth hormone: ・Decrease subcutaneous fat ・Strengthen ligaments and tendons
Side effects include: ・Physical closure（骨端閉鎖） ・Hyperlipidemia ・Glucose intolerance ・Myopathy（筋疾患)
Prevention and Treatment of Overweight and Obesity
Stage 1: Prevention Plus Stage 2: Structured Weigh Management (SWM) Stage 3: Comprehensive Multidisciplinary Intervention (CMI) Stage 4: Tertiary Care Intervention (reserved for severely obese adolescents)
National guidelines for the treatment of child and adolescent overweight and obesity recommend a staged care process based on BMI, co-morbid conditions, age, and progress with previous stage treatments. Which stage includes monitoring of food and nutrition behaviors by the adolescent and/or parent(s) as a key component?
Stage 2
What Sexual Maturation Rating stage corresponds to breast development in females and growth of pubic hair in males?
Stage 2
What stage of the national guidelines for the treatment of child and adolescent overweight and obesity involves a team of healthcare professionals who specialize in pediatric obesity management and recommends weekly visits for at least 8-12 weeks followed by bi-monthly visits?
Stage 3
Vegetarian Diets
Suggested daily food guides for vegetarians are available Vegetarian diets should be planned to provide adequate calories, protein, calcium, zinc, iron, omega-3 fatty acids, Vitamin B12, riboflavin and Vitamin D
Vitamin and Mineral Supplements for Chronic Conditions
Supplements may be beneficial for conditions to assure adequate intake
The Family/Professional Partnerships Program provides health information centers that are staffed by families who themselves have children with special health care needs.
True
Summer Food Service Program → Provides summer meals to areas with >50% of students from low-income families
Team Nutrition →Provides training, technical assistance, education, or support to promote nutrition in schools
During the early childhood years, body fat reaches a minimum of 16 percent in females and 13 percent in males
This increase in percent body fat, which usually occurs on average at 6 years of age, is called BMI rebound,
As a pancreatic lipase inhibitor, Orlistat is an FDA-approved medication for obese adolescents.
True
Calcium supplements, dairy products, and high-fiber foods may decrease absorption of iron supplements used by adolescents who have iron-deficiency anemia.
True
Children with special health care needs benefit from the same nutritional recommendations that other children do.
True
Eating concerns and disorders lie on a continuum ranging from mild dissatisfaction with one's body shape to serious eating disorders.
True
Environmental factors, or interactions between genetic and environmental factors, are the most likely causes of the dramatic rise in overweight and obesity rates.
True
Females who mature early have been found to have more eating problems and poorer body image than their later-developing peers.
True
Increases in lean body mass, skeletal mass, and body fat that occur during puberty result in energy and nutrient needs that exceed those at any other point in life.
True
Nutrition recommendations should always be considered in the context of the child's environment.
True
People with bulimia nervosa can be overweight, underweight, or of average weight for their height and body frame.
True
Protein requirements are higher for females at 11 to 14 years and for males at 15 to 18 years, when growth is at its peak.
True
Special growth charts are revised often, based on new information emerging about the natural course of rare conditions.
True
Dietary Supplements and Herbal Remedies
Use of supplements or herbs has not been shown to improve prognosis for special health needs ・However, nutritional claims abound ・Families hear from one another about various nutrient claims ・May use diet claims for one condition and expect it to work for a different condition
Ergogenic Supplements Used by Teens 4% of adolescents report taking illegal steroids
Use peaks during 9th grade Few high school athletic programs test athletes for ergogenic supplement use
Carbohydrate loading
Used with endurance athletes such as distance runners ーConsists of high-carb diet to increase glycogen stores combined with resting prior to athletic event
Well-planned vegetarian diets can offer many healthy advantages (Best when small amounts of animal-derived foods)
Vegans may have inadequate intakes -Protein -Calcium, Zinc, and Iron -Vitamins D, B6, and B12
Foods high in _______ enhance the absorption of iron from the diet.
Vitamin C
Among U.S. children, _____ deficiency is prevalent due to inadequate intakes.
Vitamin D
Claims for taking DHEA and Andro
While not scientifically proven, claimed to: -Reduce body fat -Decrease insulin resistance -Increase immune system function & LBM -Decrease risk of osteoporosis -------- Possible Side effects: -Gynecomastia (breast enlargement) -Prostate enlargement -Hirsuitism (facial hair in females)
Administration of complete nutritional supplements via a feeding gastrostomy utilizes a tube placed semi-permanently through the ________.
abdominal wall
eating breakfast, has been associated with improved academic performance in school and reduced tardiness and absences.
adequate nutrition and the establishment of healthy eating behaviors may reduce the risk of the child developing a chronic condition, such as obesity, type 2 diabetes, and/or cardiovascular disease later in life.
Mikalia refuses to maintain a normal weight for her age and height, has an intense fear of becoming fat, regularly self-induces vomiting and uses laxatives to lose weight. Based upon diagnostic criteria for eating disorders, which disorder does Mikalia exhibit?
binge-eating/purging type anorexia nervosa
Galactosemia and cerebral palsy are two conditions affecting _____, thus affecting bone growth.
calcium
The 2010 Institute of Medicine Food and Nutrition Board increased the RDA for _____ and _____ for all children, including those with chronic conditions.
calcium; vitamin D
tilized for children with uncontrolled seizures, a ketogenic diet severely limits ______ and increases ______ content.
carbohydrates; fat
On the whole, Non-Hispanic White and Asian and Pacific Islander children have better child well-being outcomes compared with the other large racial and Hispanic origin groups.
in 2010, more than one-third of American Indian, African American, and Hispanic children lived in households with incomes below the poverty level ($22,314 for a family of four in 2010), compared to less than one-eighth of Non-Hispanic White and Asian children
Many of the symptoms associated with _____ deficiency are easily mistaken for behavioral or motivational problems.
iron
What stage of psychosocial development does a young person develop their personal identity and individual moral beliefs?
late adolescence
Examples of macrosystem factors that influence eating behaviors of adolescents include ______.
mass media
What factor has been found to be the most significant predictor of childhood obesity?
maternal obesity
During middle childhood, boys have _____ per centimeter of height than girls do..
more lean body mass
The major nutrient-related consequence of cystic fibrosis is the malabsorption of various nutrients due to the lack of ______.
pancreatic enzymes
What natural source of protein, in limited amounts, would be allowed in the diet of a child with PKU?
potatoes
What food is most likely to promote dental caries?
raisins
Protein Requirements of Adolescents
recommendation is 0.85 g/kg body wt
Which lipid has the greatest influence on blood cholesterol levels?
saturated fat
The major developmental achievement during middle childhood is self-efficacy, the knowledge of what to do and the ability to do it.
snacking has increased significantly in the last 30 years, with the greatest increase in salty snacks and candy, and the greatest overall snack calories coming from desserts and sweetened beverages.
One example of a psychosocial criterion for inpatient treatment of eating disorders is ________.
social isolation
'built environment'
the overall structure and physical environment of a child's community.
Hyperlipidemia
~1 in 4 adolescents have elevated cholesterol Risk factors include: ・Family history ・Cigarette smoking ・Overweight ・Hypertension ・Diabetes ・Physically inactive
Prognosis(予後） for People with Anorexia Nervosa
~10% to 15% die from the disease Deaths related to -Weakened immune system -Gastric ruptures -Cardiac arrhythmia -Heart failure -Suicide ----------------------------------- Early diagnosis & treatment improves chances for recovery Recovery rates <50% fully recover ~33% show improvement ~20% chronically affected
Prognosis for People with Bulimia Nervosa
~2-3% die from disease Recovery rates ~48% full recovery ~26% improvement ~26% chronicity
A child's intake of vitamin D from fortified foods including milk, ready-to-eat cereals, and juices should provide 15 micrograms of vitamin D each day to maximize their absorption of calcium and ensure normal, healthy bone growth.
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Prevalence of overweight among children has increased over the last 25 years; however, recent data indicates the prevalence of high BMI has plateaued.
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The average annual growth during the school years is 7 pounds in weight and 2.5 inches in height. ( 3.2kg / 6.35cm)
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The major developmental achievement during middle childhood is self-efficacy.
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In general, the prevalence of being overweight or obese among females is highest among Mexican American teens, while among males the prevalence is highest among Caucasian teens.
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Iron deficiency is a bigger problem in middle childhood than it is in the toddler age group.
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Late adolescence corresponds to the ages of 15-17.
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Middle adolescence is characterized by the development of a personal identity and individual moral beliefs.
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The American Academy of Pediatrics recommends that children have no more than 3 hours of screen time each day.
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When determining estimated energy expenditure, categories of activity are defined in terms of jogging equivalence.
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Adolescents who use herbal supplements have been found to be less likely to engage in health-compromising behaviors, such as the use of cigarettes, marijuana, alcohol, and other street drugs.
✕ False
Bulimia nervosa and its impact on morbidity and mortality make it the most severe condition on the continuum of eating disorders.
✕ False
Each pound of body weight lost during an activity requires the ingestion of 8 ounces of fluid following the activity to maintain proper hydration.
✕ False
Parental modeling of fruit, vegetable, and dairy intake has been found to predict adolescent intake of these foods.
✕ False
Reports of children and adolescents with special health care needs estimate that as many as 75% have nutrition risk factors that warrant a referral to a dietitian.
✕ False
Supplement use is directly correlated with household income, low food-security status, and having no health insurance.
✕ False
An early BMI rebound has been associated with a decrease risk of overweight and obesity.
✕ 関係ない
・athetosis アテトーゼ/アテトーシス
アテトーゼ（athetosis）は自分の意志に反して運動を行う不随意運動の一つ。ゆっくりとねじるような運動を行うのが特徴的。脳性麻痺などが原因となる。
Fluid recommendations:
・6-8 oz fluids prior to exercise ・4-6 oz every 15-20 minutes during activity ・≥8 oz following exercise Not more than 16 oz in 30 minutes to avoid nausea
Iron deficiency
・Less common in children than in toddlers ・encourage iron-rich foods Meat, fish, poultry and fortified cereals Vitamin C rich foods to help absorption
Creatine
・Sold as supplement to increase LBM ・Naturally formed in liver & kidneys ・Main dietary sources are meats ・Studies show mixed results on benefits ・Side effects are numerous ・Chronic use may be associated with renal damage
Childhood Celiac Disease
・Underdiagnosed in children ・May interfere with learning and growth ・Once diagnosed, will need gluten free diet for life
Ephedra (マオウ)
・Was banned as OTC supplement in 2004 ・Does increase BMR but no known benefits to athletic performance ・Side effects include cardiac arrhythmia, hypertension, increased risk of myocardial infarction, cerebral vascular accidents, & death
Nutrition Intervention Model Program →Maternal and Child Health Bureau (MCH) is part of the department of Health and Human Services (HHS)
ーFunds nutrition services for chronically ill children ーDevelops and promotes model programs by funding competitive grants ・Pediatric Pulmonary Centers ・Bright Future Guidelines