nutrition 2 exam

motor development

- ability to control voluntary muscle movement - muscle control develops from the top down and from central to peripheral - influences infants ability to self- feed and the amount of kcal expended

protein requirements

- as a child grows and develops, protein is a crucial nutrient needed to provide optimal growth - current recommendations state that protien intake should comprise apprx 10-25% of the childs daily intake - this recommendation is designed to ensure that enough energy is provided to the body all nutrients so that protein is spared for growth and development of tissues ages: 1-3: .87 4-8: .76

mealtime with toddles

- as toddlers continue to advance their feeding skillls, it is crucial to provide a heathy feeding and eating environment - structure at meals can have a significant influence on childs eating patterns - suggestions to provide such a structured environment include the complete absence of television and other distractions - introduce one food at a time in order to avoid confusion or overwhelming the child

vitamins and minerals: vitamin D

- available to humasn through the photochemical action of sunlight or UV light on 7-dehydrochlosterol in skin - dietary sources such as fish oils, fatty fish - food fortified with vitamin D include cows milk and infant or supplemental formulas

growth

- birthweight doubles by 4-6 months - triples by 12 - rapid increase in total body fat in the first 9 months - length increases by 50% in first year - doubles length by 4 years - total body water decreases from ~70% to ~60% by 1 year

nutritional interventions

- breastfed infant *add infant formula powder or other modular kilocalorie supplements to pumped breast milk -formula fed infant *concentrate the formula to a higher caloric density * this can be done by concentration up to 24 kcals/oz and by modular kilocalorie supplements as needed up to 30 kcals/ oz - for the child who i taking additional solid foods, adding kilocalories to food without adding volume becomes imperative to maximize their intake

Infant vegeatrianism

- can be adequate in all essential nutrients with normal growth and nutritional standards unless extremely restricted - a breastfed infant of a well nourished vegetarian mother receives adequate nutriton, particularly if the mother pays close attention to her own intake of iron, vitamin B12 and vitamin D - women who consume three or more serving of dairy products receive sufficient vitamin D and B12 from their diet •A variety of protein-rich vegetarian foods are available for the older infant and toddler, including tofu, legumes, soy or dairy yogurt and cheese, eggs and cottage cheese. •These foods can be easily pureed or mashed for increased acceptance when the child is first introduced to complementary foods. •Later, soft cooked beans, bean spreads or nut butters on toast, chunks of tofu or cheese and soy burgers can be offered as finger foods. •Fat is an important source of energy and should not be restricted in children under two years of age. •Vegan infants will need a supplementary source of vitamin B-12 when they are weaned from breast milk or infant formula.

recommendations for energy: of total energy

- carbs: 45-65% - fat: *30-40% ages 1-3 *25% 4-18 -protein: 5-10% FOR OYUNG AND 10-30 F0R OLDER -added sugar <25% - fiber *1-3 19 *4-8 25 * boya 9-13 31 * girls 9-13 26

gastrointestinal conditions

- diarrhea * children: 3 or more loose or liquid stools per day * infants: twice the usual number of stools per day * acute: lasting less than 7 days and no longer than 14 *chronic: lasting more than 4 week * can cause dehydration * second leading cause of death and leading cause of malnutrition in children under 5 * symptom of different conditions/ disease; often infectious * prevention: safe drinking water, sanitation *treatment: hydration with hyptononic solution, reintroduction of diet or nutrition/ hydration support in severe cases * can lead to lactose/ fructose intolerance

2013 reviews of trends

- dietary intake of US children 2-6 increase in the proportion of foods that are significant sources of solid fat, added sugar, and sodium between 1989- 2008 - the predominant changes in preschool childrens per capita consumption were increased intakes of *savory snakcs *pizzas/ calzones * mixed mexican dishes *sweet snacks * candy *fruit juices * only positive was increase of fruit intake

gastrointestinal conditions: constipation

- difficulty emptying bowels: often hard stool - common in all children - typically not caused by anatomic concerns - accompaniment by irritability, abdominal pain, decreased appetite/ early satiety - diet: adequate fiber/ fluid, consistent meal pattern physical activity important - laxative and stool softeners can be used

complementary feeding

- early introduction of complementary foods and exposure to pathogens in food could result in symptomatic infection and illness in the infant and reduced sucking at the breast, followed by a decrease in the amount of milk and immune substances consumed as well as decreased maternal milk production from reduced demand - the amount of energy and nutrients needed from complementary foods will depend on the amount of breast milk or formula the infant is consuming. Although it is possible for an infant to receive adequate nutrition for the first year solely from iron- fortified formula, all infants need complementary foods for exposure to novel tastes and textures and to develop appropriate feeing skills

eating patterns

- eating patterns and nutrient intake are affected by numerous factors * eating occasions outside the home *portion size * beverage consumption *food selection * meal patterns and frequency - portion sizes * energy intake and portion sizes consumed both at home adn away from home increased significantly since 1977 * there have been changes to food patterns, foods consumed, and their contribution to energy intake * increased portion sizes and energy content of foods commonly consumer by children 1. soft/ fruit drinks 2. salty snacks 3. desserts 4. french fries 5. burgers 6. pizzas 7. mexican fast foods 8. hot dogs - however, only pizza and soft drinks have had an effect on overall energy intake

energy balance

- energy intake and expenditure to achieve normal growth and maintain a healthy body weight - one of many reasons to ensure healthful eating habits in children 2-11 years - age appropriate energy and nutrtient intakes are essential to support normal growth and development and to prevent acute nutrition problems *iron deficiency anemia * dental caries - healthy eating and physical activity patterns can also help to promote learning and academic success -reduce the risk of chronic disease, including cardiovascular disease, type 2 diabetes, cancer, obesity, and osteoporosis. 14 - american children do not consume the types and amounts of foods that are consistent with dietary recommendations - according to the DGA, while children's intakes of solid fats and added sugars exceed guidelines, many are not meeting the recommended intake for the nutrients of public health concern - calcium, dietary fiber, potassium, and vitamin D - whole grains, veggies, fruits, and dairy foods

energy and nutrient needs

- energy requirements are designed too promote an optimal rate of growth and adequate body composition - growth rates and energy needs can vary for each child - the overall energy requirements can be adjusted based on need * weight loss or . gain * weight maintenance - catch up gorwth

assessment over overweight in children

- evidence that many overweight children will become obese adults * CDC recommends using the terms overweight and at risk for overweight when addressing the pediatric population * labeling children as obese an carry a stigma for many people * obesity has been declared one of the top 10 health risk conditions in the world by the WHO - the trend for increasing overweight prevalence among children is alarming * most affected are mexican american boys age 6-11 * non hispnace african american girls aged 6-11, 12-19, 2-5

food allergies and sensitivities

- food allergy: adverse reaction to a food or ingredient in a . food that involved the bodys immune system * occur in 2-8% of children * family history of allergies increases risk * common food: milk, egg, peanut, tree nut, soy, wheat, fish, shellfish - diagnosis: skin prick, radioallergosorben test, blood test, and oral food elimination * nutrition management removal of offending food •Up to 35% of the population modify their diet fro adverse reactions to food •Many symptoms can occur •True allergy are caused by the release of histamine and seratonin •Important to distinguish food allergies - intolerances -Sensitivity •Difficulty digesting a particular food -Intolerance •Abnormal physical response to a food or food additive •Often after eating large amounts of offending food -Allergy •usually happens quickly •every time the food is eaten •can be life threatening •Food Allergy - now recognized as a protected disability in US •Allergic tendencies are inherited •Not necessarily to a specific antigen -(a parent with a bee sting allergy could have a child with a food allergy) •Children who have a fever before 1 year of age are less likely to develop signs of allergy later •Exposure to pets such as dogs builds immunity •People with allergic tendency may develop new sensitivities at any time•6 million people in the US are affected by food allergies •Worldwide it is about 3.5-4% of all individuals •Prevalence in infancy is increasing -Up to 15% to 20% infants •Both genetics and environment play a role in promoting food specific allergic responses•Most common allergens in infants -Eggs -Wheat -Milk -Fish •Most common allergens in children -Cows milk -Eggs -Soy -Peanuts -Wheat -Tree nuts -Fresh fish •Most common allergens in adults -Shellfish, peanuts, and tree nuts -Peanuts make up nearly 1/3 of all cases of anaphalaxis •Guidelines -Introduce wheat, barley, rye, oats is reasonable at 5 months -Egg at 11 months -Fish at 9 months -Try an elimination diet -Read labels -Monitor food preparation methods -Avoid cross contamination -Breast feed infants longer duration -Include plant flavonoids and carotanoids as often as possible

vitamins and minerals: fluoride

- has been demonstrated to promote tooth formationa dn also inhibit the progession of gental caries - children who begin to use fluoride toothpase before age 2 are at hgiher risk for enamel fluorosis * due to poorly controlled swallowing reflex * leads to increased ingestion of fluoride

digestive system

- healthy system needed for proper growth - can take up to 1 year for infants GI tract to mature - at birth, GI tract can handle digestion of fat, protein, and simple sugar - is able to absorb fats and amino acids - increased digestive enzymes with time - immature gut= colic, gastroesophgeal reflux, unexplained diarrhea, constipation

gastrointestinal conditions: celiac disease

- immune mediated disease of the small intestine - develops in genetically susceptible individuals when they consume gluten - prevalence is slightly higher in children - symptoms are usually GI based in children-Results in decreased absorption of nutrients from GI tract -Treatment: removal of gluten from diet -Intestinal biopsy is gold standard for confirming diagnosis -Increased risk associated with certain conditions (type 1 diabetes, syndromes, autoimmune thyroiditis, immunoglobulin A [IgA] deficiency, and a first-degree relative with celiac disease) -According to the National Institutes of Health (NIH), six elements are essential for management of celiac disease: C: Consultation with skilled dietitian E: Education about celiac disease L: Lifelong adherence to a gluten-free diet I: Identification/treatment of nutritional deficiencies A: Access to advocacy group C: Continuous long-term follow-up

nutritional assessment

- includes a thorough medical, social, and nutritional evaluation - should include a complete history and physical * pre nantal and perinatal history * clinical examination * family history (especially of older siblings) - assessment performed by a nutrition professional is most essential - intake and output - breast feeding - formula feeding * improper dilution is most common error

Early Feeding

- infantile colic is characterized by paroxysms of uncotrolled crying or fussing in an otherwise healthy and well nourished infant - the crying and fussing behavior can be described by the rules of threes - starts at 3 weeks - there is more than 3 hours of crying a day for at least 3 days a week - lasts for more than three weeks - colic resolved spontaneously without any further sequelae

satiety

- infants and young children can sense when they are full - turning their heads away or putting up their hands can be signs that an infant is finished eating

meal planning guidelines

- meet the needs of different type of vegetarian diets - help vegetarians meet the msot recent nutrient recommendations - focus on specific nutrients identified as being of special importance to vegetarians - include a wide variety of foods - meet the needs of different age groups

nutrient requirements

- need to support growth and body composition for good health - energy * breast milk and or formula are the main sources of calories up to 1 year * calorically dense appropriate solid foods - protein * higher per kg needs than for adults * recommendations based on composition of human milk * require larger percentage of essential amino acids than adults * the most recent recommended adequate intake of protein for infants from birth to six months is 1.5 g/kg/day - fatty acids * minimum of 30 grams of fat up to age 1 * adequate in breast milk and formula * in addition to the essential fatty acids, linoleic and alpha linolenic acid; there is growing concern that infants also need long chain polyunsaturated fatty acids in their diets: for neural development and visual acuity - iron * iron deficiency anemia is the most common childhood nutritional deficiency worldwide *increasing * consequences include delays in otor and cognitive development caused by irreversible brain injury * babies are born with adequate for 6-9 months of life *significant increase in requirement between 4-12 months *supplementation is controversial -*women, infants, childnre, created in 1972, resulted in a dramatic decrease in iron deficiency across all socio- economic groups * routine screening began in 1980s - Zinc * defiency is prevelant in undernourished children and is linked to reduced activity and play with subsequent poor developmental outcomes *human milk can meet needs for first 6 months *deficiency is associated with poor growth as well as diarrheal disease * complementary foods when introduced beyond 6 months can help with intake - vitamin D * breast fed infants are at risk of deficiency *is associated with rickets *is now fortified in infant foods and supplemented into breastfed infants * recommend 400iu/ day - after 6 month complementary foods are needed to provide *125 vitamin A *25-50% copper *50-75% thiamin, niacin, manganese *up to 98% for iron and zinc

feeding skills and neuromuscular development

- newborn to 6 months of age: the sucking reflex is quite strong in the newborn and can be easily elicited by stroking the infants lips, cheeks, or inside the mouth - by about 3 months sucking becomes less automatic and more voluntary. Gag reflex is present in 3rd trimested and is stimulated by contact of posterior two third of the tongue. This reflex gradually diminished to one quarter of the posterior tongue by 6 months - the rooting reflex that assists the infant to locate the breast and nipple by turning the head side to side and opening the mouth wide when the skin surrounding the mouth is stroked disappears by three months - advances motor skills * infants will need new oral and motor skills in order to transition from a full liquid milk based diet t a more solid diet of complimentary foods * disappearance of the rooting and sucking reflexes * accompanying change in anatomy help prepare the infant for this transition *phasic biting 1. resulting in the rhythmical opening and closing of the jaw when the gums are stimulated 2. disappears between three and four months of age - between 6-9 months * it becomes possible for the infant to receive a bolus of food without reflexively pushing it out - by 12 months * rotary chewing is well established * along with sustained controlled biting * permits the infant to consume a variety of foods

growth charts

- nutritional status of children is assessed by plotting height and weight on growth charts - helps to determine adequacy of nutrient intake, particularly calories and protein - current charts are from 2000 WHO growth standrads used for birth-2

physiological and psychological development

- organs and systems developed during gestation continue to develop * central nervous system *motor skills *cognitive *digestive

growth and development

- peak height velocity * the adolescents growth spurt takes 2-4 years to complete *generally longer in boys than girls - the average hight velocity is 5-6 cm/ year during adolescence - peak is 8-10 -Girls •On average, begin pubertal growth spurt at age 9 •Achieve maximal rate of linear growth (peak height velocity) at an average age of 11.5 years Corresponds with Tanner stages 2 and 3 -Boys •Onset of pubertal growth spurt occurs at age 11 •Peak height velocity occurs at age 13.5 years •Tanner stages 3 and 4 •The onset of the adolescent growth spurt is more closely associated with bone age than chronologic age -What this means is that boys, because their peak height velocity is greater than girls, 9.5 cm/yr vs. 8.3 cm/yr and because peak height velocity occurs later in boys than girls, are on average 13 cm taller than girls •During adolescence, girls gain fat mass (FM) at an average rate of 1.14 kg per year. •In contrast, boys do not experience a significant increase in absolute fat mass. •Boys also gain fat-free mass (FFM) at a greater rate and for a longer period of time than girls •As a result, boys are relatively leaner than girls post-puberty•Bone growth and mineralization. • •Bone mass doubles between the onset of puberty and young adulthood. • •Growth of the skeleton occurs via modeling which changes both the size and shape of the bones. • •Bones increase in length and diameter • •After puberty the growth plate becomes mineralized and long bones (epiphysis) fuse - preventing further growth •Calcium Absorption and Retention -Maximum rate of calcium accretion in skeleton: •Girls: 11 to 14 years •Boys: 16-18 years -Biomarkers of bone formation and resorption are increased during puberty •Mechanical stress on the skeleton is critical to bone growth and development -Physical activity during adolescence is necessary to maximize peak bone mass

cognitive development

- related to adequate kcal and protein intake - also need stimulation through social and emotional growth

vitamins and minerals: iron

- requirements for iron intake are based on age and iron sores - during periods of rapid growth, the body's need for iron increases - iron can be calssified as being derived from heme or non- heme sources * heme: absoprtion is found to be higher than from non- heme iron; sources include animal meats and products, such as beef and chicken *non- heme: sources include fortified grains, fruits and veggies - iron deficiency anemia * most common nutritional deficiency int he world remains relatively common among at risk age groups in US * risk facts include low household income, lack of consistent medical care, poor diet quality, and parents with minimal education * calcium and iron compete for absorption at the same receptor sites within the body - increasing iron in the diet * include protein sources with meals * serve iron enriched or fortified grains * offer oatmeal or cream of wheat at breakfast * add foods high in vitamin C to the meal * add pureed meats to pasta sauce or casseroles for toddlers - baked potato skin

Food safety

- safe handling of infant formula *bottle- fed infants are at increased risk for exposure to food- borne pathogens, particularly if the bottles are left at room temperature for several hours - safe handling of complementary foods *infants are at risk of exposure to food borne pathogens when complementary foods are not prepared using safe food handling techniques

dietary trends affection overweight

- sedentary lives: lack physical activity and excessive tv viewing - eating a highly processed, synthetic diet; typical American diet today is lower in fiber and plant foods, higher in meat, high in highly refined carbs - family eating environment of today - household food insecurity

when is an infant ready for solid food? what foods to start with?

- sit with support - open mouth to spoon/ food - does not push food back out with tongue - seems interested in food *single grain cereals * veggies *fruits *meats

formula

- standard formula is 20 kcal/ ounce - speciality formulas may have different kcal and protein amounts

central nervous system

- system is immatire - inconsistent or subtle cues of hunger or need

apgar score

- test given to infants in the delivery room or birthing room - designed to quickly evaluate a newborns physical condition after delivery - helps to determine any immediate need for extra medical or emergency care - checks heart rate, muscle tone, and other signs - higher score is better - 7 or above is good health - perfectly health babies have a low rating especially in first few minutes after birth - a slightly low score at 1 min * high risk pregnancy * through a C section * after a complicated labor and delivery * preamturely

failure to thrive

- the american academy of pediatrics utilizes two criteria for diagnosing - the first of these is when eight falls less than two standard deviations below the means (z scored less than -2) for sex and age matched after having achieved a previously stable growth pattern - the three factors that lead to energy imbalance in the FT population are: 1. inadequate energy intake 2. inefficient energy utilization 3. increased energy expenditure

Low carb diet or gluten free

- the gluten free food market will be valued at 12.5 billion by 2025, which is nealy double the current value •The growth can be attributed to increased consumer consciousness about the health benefits of a gluten-free diet • •Celiac disease is an autoimmune condition •Wheat allergy is an immune response (not auto-immune) •Non-celiac gluten sensitivity remains undefined • •A gluten-free diet is only necessary for people diagnosed with Celiac Disease or gluten intolerance •Considered a fad diet and going gluten-free isn't the best way to diet. •Low-Carbohydrate Diets •Can be much more restrictive then gluten free diets •Carbohydrates are found in what type of foods? -Grains (bread, cereal, pasta, rice) -Vegetables -Fruits -Milk products •Lactose! • •Complex carbohydrates found in food can provide fiber, antioxidants, vitamins, and minerals • •Some evidence that a low-carb diet may help people lose weight more quickly than a low-fat diet - and may help them maintain weight loss •The low-carb diet was most beneficial for lowering triglycerides

childrens current food and nutrient intake

- the nutrient intake of children ages 2-11 in the US continues to fall short of the recommendaions outlined in the dietary reference intakes which provide specific recommendations for children *1-3 *4-8 *9-13

childhood obesity

- the prevalence of childhood obesity increased rapidly during the 1980s and 1990s * doubling or tripling in some age groups - recent national health and nutrition examination survey data indicate that the rapid increases have not continued and rates have stabilized - in 2009-2010, 16.9% of US children and adolescents were obese (defined as body mass index bmi fir age > or equal 95th percentile) - prevalence rates higher among teens than preschool aged children - higher among boys than girls

vitamins and minerals: calcium

- the principal mineral required bu the body for the process of bone mineralization - toddlers and young children have an increased need for calcium - calcium promotes the rapid bone growth and skeletal development that takes place during the early years of life - ways to increase: drink milk, use heated milk is food/ drinks, add dairy like cheese to sandwichs or casseroles, add cheese to cooked veggies, substitute milk and yogurt in recipes for cream or sour cream, add almonds to break or muffin recipes, drink calcium fortified drinks such as OJ

Foods at one year

- toddlers often eat at 6 small meals each day, versus 3 larger meals - suggested that toddler serving size be 1/4 to 1/2 that of adults - portion sizes are very important - food that may promote choking * hot dog slices * carrot rings * whole grapes *nuts *popcorn *hard candies * large beans

food insecurity

- underweight, chronic malnutriton, and severe nutrient deficiencies are rare among children in the US - food insecurity can have profound and long lasting effects on young children - nearly 16 million children are estimated to line in food insecure households * access to nutrition and feeding programs in child care * comprehensive school nutrition services - environmental factors, including family, child care, schools, and advertising, can influence the eating habits of young children

fat requirements

- until age 3, dietary fat plays a large role in brain development - fat comprises approx 60% of the central and peripheral nervous system that essentially control, regulate, and integrate every body system - it is essential that growing toddles obtain adequate fat from their diet - if excess weight gain is a concern, often only minor changes in dietary choices are needed * recommendations are usually to keep fat intake at or below 30% of daily calories to promote optimal growth - most fat intake should be from poly and monosaturated fats * foods high saturated fats should be offered in less frequently

pediatric vegetarianism

- vegetarian diets can be very low in sever nutrients: protein, energy, some vitamins and minerals - not generally recommended for infants or children - some self described vegetarians eat fish, chicken or even meat reasons: family members, health, animal welfare, environmental concerns health benefits: lower BMI, reduced risk of cardiovascular disease, lower blood pressure and risk of hypertension, reduced risk of type 2 diabetes, lower risk for prostate and colorectal cancer

water

- very important but often overlooked component of daily diet - helps the body maintain homeostasis - allows for transport of nitrients into cells - functions int he removal of the water products - should be offered for hydration - not to replace milk or formula

baby bottle tooth decay

- weaning from a bottle around 1 year - allowing a child to fall asleep with a bottle can lead to pooling of milk/ formula in mouth - sugars provide food for bacteria in the mouth - dental carries can occur

gastrointestinal conditions: reflux

-Gastroesophageal reflux (GER): the passage of stomach contents into the esophagus, or throat -GER and GERD happen when a child or teen's lower esophageal sphincter becomes weak or relaxes when it shouldn't, causing stomach contents to rise up into the esophagus -Sometimes accompanied by regurgitation, spitting up, or vomiting -Majority of infant reflux typically resolves by 12-14 months of age -Gastroesophageal reflux disease (GERD) •Occurs when GER is accompanied with weight loss/poor weight gain, wheezing/cough, pneumonia, irritability, refusal of feedings, esophagitis, and in severe cases apnea -Treatment: nutrition and feeding interventions, medications -Goal of nutrition management: decrease symptoms while promoting expected growth and development -Foods should not be eliminated unnecessarily -For infants, thickening feeds is moderately effective

childrens current food and nutrient intake: 2

-in addition to the overconsumption of energy, SOFAS and sodium the 2010 DGA recognized four nutrients of public helth concern, based on the low population intakes *dietary fiber * calcium *vitamin D *potassium

eating disorders

Anorexia Nervosa (AN) •Characterized by a relentless pursuit of thinness •Individuals with AN may achieve very low body weights via severe restriction of the amount and types of food eaten and excessive exercise •Patients with bingeing/purging subtype of AN occasionally use self-induced vomiting, laxatives, or diuretics to control their body weight •AN is a progressive condition •As weight loss progresses, impaired cognitive function, depression, anxiety and social isolation worsenBulimia Nervosa (BN) •Also desire thinness, but their chronic dieting is interspersed with recurrent episodes of binge eating, followed by compensatory purging behaviors (self-induced vomiting, to "undo" the effects of the binge) •Most patients are of normal bodyweight. • Eating Disorders Not Otherwise Specified (EDNOS) •Nearly identical to AN or BN •Not meet all of the diagnostic criteria for AN or BNRisk of malnutrition and altered: •serum calcium, magnesium, and phosphorus •altered liver function •cardiovascular implications •lowered bone density •lowered estradiol or testosterone •Possible life-threatening lowered BMI •Weight gain goal • •Safe Refeeding • •Replete micronutrient deficiencies • •Normalization of eating and exercise patterns

minerals

Calcium •Recommendation based on maximal calcium retention •Calcium balance studies indicated that retention increased with dietary intake up to 1300 mg/day •Recent longitudinal data of bone mineral deposition suggest that calcium requirements may be higher during peak calcium accretion: -1500 mg for girls -1700 mg for boys - dairy foods supply 75% of the calcium in the american diet Iron •Iron requirements increase during adolescence to meet the demands of growth and inevitable losses •Iron is lost from the gastrointestinal tract, skin, urine, and menstrual blood in females. • Sodium. •Average daily sodium consumption has increased by approximately 1000 mg for adolescent boys and girls between NHANES I (1971-1974) and NHANES (1999-2000). •Average sodium intake for teenage boys was about 4,000 mg and 3,000 mg for girls Vitamin D •AI for vitamin D is 5 µg (200 IU) for individual 1 to 5o years old •Synthesis of vitamin D in the skin is adequate to meet the requirement with sufficient exposure to ultraviolet light •Skin vitamin D synthesis is reduce by the use sunscreen •Individuals with darkly pigmented skin have reduced ability to synthesize vitamin D -At greater risk for insufficiency when dietary intakes are marginal •Dietary intake of vitamin D among adolescents varies by ethnicity -Non-Hispanic Caucasians had the highest intakes of vitamin D -African Americans the lowest intake - fortified milk and foods are primary dietary sources of vitamin D•Current recommendations for vitamin D are likely too low based on calcium absorption • •Without ultraviolet synthesis of vitamin D, 800 to 1,000 IU of dietary vitamin D as day is needed to maintain serum vitamin D concentrations

Disorders of Carbohydrate Metabolism: Galactosemia

Clinical Symptoms and Diagnosis of Galactosemia •Vomiting, liver enlargement, and jaundice are often the earliest signs of the disease, but bacterial infections (often severe), irritability, failure to gain weight, and diarrhea may also occur•Nutrition therapy is to provide a galactose-free diet by using galactose-free foods. • •Galactose is found mainly in milk and dairy products as part of lactose, but is also contained in galactoproteins and galactolipids in other foods (meat, dairy, cereals, peas, lentils, some legumes, organ meats, cereals, and some fruits and vegetables).

dietary guidelines for athletes

Energy •Total energy expenditure (TEE) -sum of resting energy expenditure (REE), dietary-induced thermogenesis (DIT), and physical activity (PA) -varies with gender, age, and body size •Physical activity accounts for 10% to 15% of total energy expenditure -Athletes in strenuous training programs or endurance athletes may increase TEE by 2- to 3- fold due to physical activity -Ex: cyclists in the Tour de France - may expend up to 8,000 kcal / day•Accurately determining energy needs from prediction equations is challenging •Inter-individual variation in REE is large •Energy expended during physical activity varies with exercise duration and intensity • What is the best way? •Changes in body weight and/or composition may be the best way for athletes to self-monitor their energy balance over time Carbohydrate •Dietary carbohydrates have a metabolized energy density of 4 kcal/g •Readily digested and absorbed •During exercise, glucose is the preferred substrate for ATP production •For this reason, and to replenish hepatic and muscle glycogen, athletes should consume 60-75% of their energy from carbohydrate •Endurance athletes are recommended to consume from 6 to 10 g carbohydrate/kg body weight -Assuming the athlete is normal weight •Carbohydrates are the main energy source for athletes for a variety of reasons -CNS and red blood cells have high glucose requirement -RBC do not have mitochondria (they can not oxidize fat), they rely on ATP produced from glycolysis -Dietary carbohydrates are needed to replenish liver and muscle glycogen stores - •Inadequate carbohydrate intake necessitates gluconeogenesis from dietary or endogenous amino acids because fat cannot be used to make glucose ••Glucose is the most abundant dietary monosaccharide •The most abundant dietary disaccharide is sucrose -sucrose (table sugar) = glucose + fructose -lactose (milk sugar) = glucose + galactose -maltose (product of starch digestion) = glucose + glucose •Short chains of glucose link together to form maltodextrin and dextrose •These are the "complex carbohydrates" frequently found in sports drink •Polysaccharides typically contain thousands of glucose molecules - found in grains, legumes, some vegetables -•For overall health, most dietary carbohydrates should come from unrefined grains whole grains, legumes, and fresh fruits and vegetables •Unrefined grains provide more fiber and vitamins than highly processed grains Protein •Dietary protein has a metabolized energy density of 4 kcal/g (same as carbohydrate) •Protein is broken down once digested into amino acids •Typical sources of protein include: -Meat -Dairy products -Eggs -Plant sources •Soy products •Legumes (lentils) •Chickpeas •Nuts •Quinoa vIf energy or carbohydrate intake is insufficient, amino acids from dietary protein or from breakdown of endogenous protein (muscle) are used for gluconeogenesis • •Athletes have slightly higher protein requirements than non-athletes •Athletes should consume 1.2-1.7 g protein per kg BW to maintain lean body mass -Endurance athletes:1.2-1.4 g pro/kg to maintain lean mass -Strength trained athletes: 1.6-1.7 g per kg to maximize muscle hypertrophy •Vegetarian athletes have greater protein requirements: 1.3-1.8 g/kg because of the low "quality" of plant-derived proteins Fat •Dietary fat is a more concentrated source of energy than carbohydrate or protein • •Metabolized energy density of 9 kcal/g • •For this reason, and because of the association between diets high in fat and cardiovascular disease, some women athletes restrict their fat intake.•However, dietary fat plays an essential role in maintaining health • •It is needed for absorption of the fat-soluble vitamins (vitamins A, D, E, and K) and vegetable oils are excellent sources of the antioxidant, vitamin E • •Fatty acids are incorporated into cell membranes and are required for normal immune function•It is recommended that athletes consume moderate amounts of fat (20-25% of energy) •No less than 15% of their total energy from dietary fat, preferably polyunsaturated fats -Ex: athlete needs 2,500 kcal/day •At least 375 kcal should be from fat •This would be equivalent to about 42 g of fat (375 / 9 = 42 g ) •Changing the amount of dietary fat is as easy as increasing or decreasing the amount of fat added to foods, like butter or cream cheese on breads, salad dressings, mayonnaise in foods, oil in cooking •One tablespoon of oil contains 10 g fat and 100 calories

types of diabetes in children

Pathogenesis of Type 1 Diabetes •The classic model for type 1 diabetes is the genetically susceptible child exposed to an environmental trigger •Results in pancreatic beta cell autoimmunity and eventual self-destruction -Mechanism have yet to be identified •Type 1 diabetes is a complex disease despite responding to genetic influences •Having a first-degree family member with type 1 diabetes increases risk of developing the condition •85% of those diagnosed have no family history of the diseasePathogenesis of Insulin-Resistance •Insulin resistance often manifests during puberty •Although diagnosis of type 2 diabetes may occur in later years •Maturity onset diabetes of the young (MODY) only occurs in a small subset of these children •Cases of MODY reflect a genetic defect that affects insulin secretion but not insulin action • •Many other types of diabetes classification exist but are rare in children.The overall management goal in pediatric diabetes is similar to that for adults: • •Medical nutrition therapy is an important factor in achieving both glycemic control and normal growth and development. • •Macronutrient distribution is based on adult recommendations but should be tailored to meet individual needs. • •Total calories should be balanced between needs for growth and prevention of obesity.

The Effect of Intense Physical Training: Childhood through Adolescence

Risk of: •Insufficient growth due to energy drain •Sexual maturation can be delayed •Iron deficiency anemia (females) •Bone density •Children and adolescents have higher energy and protein needs per kilogram of body weight than adults -Need to support growth •Weight bearing physical activity has a greater effect on bone mass in children and adolescents compared with adults •The effects of growth and development are closely related to the energy drain created by the physical activity -Before puberty - can delay growth and maturation -Decreased weight and height velocities in elite female athletes •Children and adolescents are also more susceptible to heat-related illnesses - greater impairment of thermal regulation with dehydration

dietary patterns

Serving Size •Average serving sizes for foods eaten at home and away from home have increased during the past 30 years •Foods frequently consumed by adolecents have significantly increased -Salty snacks -French fries -Ready-to-eat-cereals -Soft drinks •Consumption of these low nutrient dense foods is associated with higher energy intake and lower consumption of vit A, folate, calcium, phosphorus, and magnesium•Skipping Breakfast - -1/5th of adolescents report skipping breakfast. • •Fast Food Consumption -Most adolescents frequently eat meals and snacks away from home -In one study, 26% of all meals and snacks were consumed away from home, accounting for 32% of total energyAdded Sugars •Adolescents have the highest intake of added sugars than any other age group •Approximately 40% of added sugars are consumed in carbonated soft drinks -Soft drinks supply 8% of total energy intake among adolescents -Overweight adolescents derive more of their daily energy intake from soft drinks than normal weight teens -Teenagers consumes more carbonated soft drinks than they do fruit juices, fruits-ades, or milk ••Consumption of foods and beverages that are high in sugar was associated with poor diet quality, including reduced intakes: -Calcium -Iron -Folate -

childhood overweight overview

bmi for children: in pediatric population the BMI is used as a screening took and not a diagnosis growth charts: at risk for overweight > or = 85th percentile to 95 & overweight is above or equal to 95 percentile

health issues

failure to thrive: is defined by inadequate physical growth diagnosed by observation of growth over time using a standard growth chart. This failure to maintain adequate growth can be cause by a multitude of factors: - organic: inability to meet calorie needs due to medical conditions, malabsorption, increase metabolism with specific disease states - inorganic: food shortage, incorrect mixing of formula, or neglect lactose intolerance: stomach pain, flatulence, and loose stools in association with milk/ products dental health: introducing a toothbrush during the toddler years and initiate a good oral hygiene routine that continues through life

growth expectations

growth is measured and plotted on standard center for disease control growth charts based on age and sex - head circumference and weight for height are measured and plotted until 36 months - after age 2 body mass index is sued to assess appropriate weight for height - growth rates may vary considerably for each individual child this is thought to be associated with a variety of factors, including parents growth history patterns - it is essential for clinicians to note that approx 25% of normal infants and toddlers in the first 2 years of life will drop to a lower growth percentile and subsequently remain on this new growth track

Organic Failure to thrive

is lack of growth associated with an identifiable disease or disorder - almost all chronic illnesses in childhood can result in poor weight gain related to any of the factors

non organic failure to thrive

is present in majority of all diagnosed case - children have non organic failure to thrive when their lack of growth cannot be attributed to an identifiable disease - the cause is psychosocial origin

nutrition and health status

nutrition and health status of young people an important determinant of health status - healthy people 2020 added serveral new objectivves that are directly linked to child nutrition - high priority issues and actions are called leading health indicators * include total vegetable intake for indivudals 2 years and odler * children and adolescents who are considered obese - the 2010 dietary guidelines for americans, the white hourse task forces on childhood obesity report, and the lets move initative

food issues

picky eating: picky eating can be common in toddles adn may continue throughout childhood grazing: grazing may produce a constant feeling of fullness and cause the child to never eat an appropraite amount at a meal, therefore not expanding the sotmach size snacks: toddlers and children have a comparatively small stomach size and cannot consume large amounts at meals, therefore snacks are able to provide needed servings of healthy foods

nutritional considerations for childhood vegetarianism

protein: - not a huge concern- intake rarely below recommendations if energy intake is adequate from a variety of foods - plant proteins contain varying amount of amino acids Iron and Zinc: - iron intake varies non- heme iron * only forms found in vegetarian diets lower absorption rate than heme iron inhibitors and enhancers affect absorption of iron and zinc because of the lower bioavailability of iron from vegetarian diets a separate iron RDA has been established: based on 1.8x the RDA for nonvegetarians calcium and vitamin D: - lacto ovo vegetarian diet adequate intakes of calcium - vegan children may have lower intakes (no dairy) - vitamin D from fortified food Vitamin B12 - found only in significant amounts in food derived from animals or fortified foods Omega 3 fatty acids: - vegetarian diets generally low: unless they consume eggs or generous amounts of sea vegetables - micro-algae supplementation fax-seed oils, soybean oil, walnuts, spy products

health effects of the overweight

risk of: insulin resistance/ hyperinsulinemia and non- insulin dependent diabetes - metabolic, hemodynamic, thrombotic, and inflammatory disorders (hypertension and dyslipidemia) - mental health problems, such as depression, anxiety, lowered self esteem and sometimes eating disorders

Position of the Academy of Nutrition and Dietetics: Nutrition Guidance for Healthy Children Ages 2 to 11

•"It is the position of the Academy of Nutrition and Dietetics that children ages 2 to 11 years should achieve optimal physical and cognitive development, maintain healthy weights, and enjoy food, and reduce the risk of chronic disease through appropriate eating habits and participation in regular physical activity"

Phenylketonuria (PKU)

•A form of hyperphenylalaninemia, defined as plasma phenylalanine value above 120 uM (2 mg/dl). • •Untreated, PKU can result in severe to profound mental retardation and behavioral difficulties. The severity of the disease can vary with each affected person. • •Mild or moderate PKU are less severe forms and carry less of a risk for brain damage, however most patients with the disorder will need to follow a lifelong restricted diet.•Treatment of PKU involves the immediate and lifelong avoidance of excess dietary phenylalanine. • •It was once thought that the diet could be discontinued in adolescence, but today it is recommended the diet be followed for life. • The diet provides supplemental tyrosine and small amounts of PHE for essential functions•Women with PKU, who have elevated levels of phenylalanine during pregnancy, are at an increased risk of giving birth to offspring with intrauterine growth retardation, psychomotor retardation, microencephaly, and congenital heart defects. • •The best fetal outcomes are seen with strict control of blood phenylalanine 10 weeks before pregnancy and maintained throughout the entire pregnancy.

nutrient requirement: growth

•Absolute nutrient requirements are increased compared with childhood -increased growth and body size •Adolescent boys have greater requirements for most nutrients compared with girls -Differences in growth and development •The exception is -Iron -Girls need more iron than boys due to menstrual losses

athletes vitamins and minerals

•Athletes may require more of some nutrients than non-athletes due to increased: nutrient excretion, metabolic waste production, and tissue synthesis and repair. However, the increment is small relative to the safety factor. •Iron - Endurance athletes, regardless of gender, are more likely to become iron-deficient than non-athletes. •Calcium - also is a mineral that is likely to be lacking in the diets of athletes, particularly vegans and women. •Fluid and Electrolytes - Dehydration due to an imbalance between fluid loss and intake is the most common cause of heat-related illness in athletes. Athletes may lose water at a rate of 0.5-1.5 L/hour and up to 6-10% of their body weight •Pre-exercise - Ensure euhydration by drinking fluid volumes that produce colorless urine in the 24 h prior to competition. The day of the event, consumption of 16 ounces of fluid 2-3 hours prior to the start will allow time for excretion of excess water in urine before the competition begins • •Hydration during Exercise - athletes should drink 8-12 ounces of fluid every 15-20 minutes during exercise. If a training session or competition exceeds one hour, a commercial fluid replacement beverage that contains carbohydrates and sodium is superior to plain water. •Post-exercise Hydration - Rehydration after exercise is important because most athletes do not consume enough fluids during exercise to replenish the fluid lost in sweat and respiration. An athlete should consume 24 ounces of fluid for every pound of weight lost during exercise. •Nutrition during Exercise -The recommended carbohydrate intake during exercise is 30-60 g of carbohydrate per hour. Drinking 16-32 ounces of a 4-8% carbohydrate, commercial fluid replacement beverage every hour, would meet this guideline. •Nutrition Post-exercise - Post-exercise, elevating blood glucose levels quickly is beneficial to replenish glycogen stores, so high GI foods are recommended. Athletes should aim to consume 1.5 g carbohydrate per kg BW in the first 30 minutes after exercise and again every 2 hours for 4-6 hours post-exercise

macronutrients

•Average daily energy consumption assessed in NHANES I (1971-1974) and III (1988-1994) has remained relatively constant •Exception - adolescent females energy intake increased from 1,735 to 1,996 kcal/d • •The proportion of energy derived from fat and saturated fat decreased over time •Remains above the recommendations in the Dietary Guidelines at 33.5% for total fat and 12.5% for saturated fat (less than 10% is recommended)

body composition

•Boys: -age 8-10 average 15% body fat & 24 kg fat free mass -Age 18-20 (post puberty) 13% body fat, 60 kg fat-free mass •Girls: -age 8-10 average 20% body fat & 24 kg fat free mass -Age 18-20 (post puberty) 26% body fat, 44 kg fat-free mass -

cognitive and psychosocial development during adolescence

•Cognitive development enhances the ability to regulate affect •However, emotion alters decision-making thought processes and behaviors •Decision making behaviors that effect health, including diet and exercise, are highly influenced by emotion and social influence, despite understanding of associated risks and benefits

cystic fibrosis

•Cystic fibrosis (CF) -Autosomal recessive genetic disorder -Result of a defective cystic fibrosis transmembrane conductance regulator (CFTR) •CFTR is a protein that allows chloride to cross all cell membranes -Secretions become sticky and thick and affect organ systems•There is a general dysfunction of mucus-producing exocrine glands •High levels of sodium and chloride in the saliva, tears and sweat •Lung disease in CF is characterized by decreased airway surface liquid volume and subsequent failure of normal clearance ••CF affects approximately 30,000 children and adults in the US •CF is most common among Caucasians of European decent -About 4% carry the CF allele•Neonatal screening leads to significant nutritional benefits •A majority of CF patients have been diagnosed by age 3 •About 10% are not diagnosed until age 18 or older •Early diagnosis of CF and aggressive nutritional therapy are important to prevent growth failure and malnutrition •Cystic fibrosis (continued) -Often leads to poor weight gain and growth -Requires increasing calorie, protein, and fat intake, management of pancreatic insufficiency and fat-soluble vitamin replacement •May require nutrition support to meet increased needs -Can lead to distal intestinal obstruction syndrome •Treatment: hydration, stool softeners, enema •Rare cases require surgical intervention •CF patients may need to be given 110% to 200% more calories •Calorie intake 150 kcal/kg for children and 200 kcal/kg for infants •This may mean 3,000 to 4,000 calories for teens •Glucose level need to be monitored and managed •Fat-soluble vitamins needed to supplement the diet -"ADEKs" •Use liberal amounts of salt to replace losses

epilepsy and seizure disorder

•Epilepsy is a disturbance of the nervous system with recurrent seizures, loss of consciousness, convulsions, motor activity, or behavioral abnormalities • •The seizures result from excessive neuronal discharges in the brain •There are many forms of epilepsy •Approximately 45,000 children under the age of 15 develop epilepsy each year -Often those with spina bifida or cerebral palsy •1 out of 26 people will develop some from of epilepsy •Nutritional concerns -Antiepileptics drug side effects -Bone health •Decreased metabolism of vitamin D •Resistance to parathyroid hormone •Inhibition of calcitonin secretion Impaired calcium absorption •Nutritional concerns •Ketogenic Diet - should be considered -Severely restricted carbohydrates (induced state of ketosis) -Adequate protein, high-fat diet -Biochemically mimics fasting state -Ratio of 3:1 or 4:1 fats to carbohydrates -Gradual approach to changing diet is preferred-Not used for everyone, special factors should be considered -Sometimes admitted to hospital for diet initiation -Lots of follow up -Palatability makes it difficult for long-term use -Patients consuming this diet produce ketone bodies -Increase the brain energy molecule ATP as well as levels and actions of other neuromodulators -Both are important modulators of seizures •Objective is to use a combination of medications and ketogenic diet to minimize seizures

sociodemographic moderators of dietary intake

•Gender, ethnicity, parental income and education affect diet quality in adolescents. • •Advertising and marketing of foods and beverages influences the food preferences, purchase requests, purchase and consumption of children and youth. • •The recent increase in adolescent overweight and obesity has brought the food environment in schools under increasing scrutiny.

newborn screening and genetics

•Heel prick test •Detects possible conditions at birth -Examples: amino acid metabolism disorders, organic acid metabolism disorders, fatty acid oxidation disorders, carbohydrate metabolism disorders, and various endocrine disorders -Many conditions are considered to be inborn errors of metabolism that require nutrition interventions as part of their treatment - •Nutritional management using restricted diets and medical nutritional foods are principal components of disease treatment

Eating Disorders and the Female Athlete

•In an effort to achieve or maintain an unrealistically low body weight or percentage of body fat, some athletes restrict their food intake so severely that endocrine function is disrupted. •Women experience irregular (oligomenorrhea) or absent menstrual cycles (amenorrhea) •Thyroid hormone (tri-iodothyronine) is decreased in both genders, resulting the signs and symptoms of decreased metabolic rate: -bradycharida, hypotension, slowed respiration rate, delayed reflexes •These hormonal changes have a negative impact on bone mineral content and density •Bone turnover becomes uncoupled when energy availability is 10 to 20 kcal/kg lean body mass per day • •Measureable loss of bone mineral density is evident after missing only six consecutive menstrual cycles • •Loss of bone mass is insidious because it is irreversible and often proceeds undetected for long periods of time•There are other negative consequences of chronic low energy availability •Protein turnover is slowed, making athletes more susceptible to injury, illness, and overtraining syndrome •Inadequate energy intake forces the body to rely on other energy sources •The body uses energy that is stored body fat and breaks down muscle, converting the protein into glucose •Loss of skeletal muscle results in loss of strength and power, with negative effects on performance

maple syrup urine disease

•Maple syrup urine disease (MSUD) is a defect in the metabolism of the branched chain amino acids (BCAAs) -isoleucine, leucine, and valine. • •The clinical symptoms that occur in MSUD are the result of neurotoxicity from the accumulation of leucine, valine, and isoleucine, and their a keto acids •Elevated urine concentrations result in a maple syrup odor •Infants will exhibit a sharp cry, lethargy, vomiting, loss of normal tendon reflexes, poor sucking ability, respiratory failure, metabolic acidosis, alternating flaccidity and rigidity, leading to spasms of the body with the back fully arched and the heels and head bent back, and seizures •Long-term nutrition therapy is required to provide a restricted, yet appropriate dietary BCAA intake • •Goal is to support optimal growth and development while maintaining plasma concentrations of BCAA at nontoxic levels • •Timely initiation of nutrition therapy is key to preventing impaired physical and mental development

pediatric diabetes

•More than 150,000 children in the U.S. have type 1 diabetes •The incidence of type 1 diabetes peaks in children both between 5 and 7 years of age and at puberty •Incidence rates vary considerably among different countires •The U.S. has an incidence rate of about 16 per 100,000 • •Until recently, children and adolescents diagnosed with diabetes were assumed to have type 1 diabetes of an autoimmune etiology.•Currently, children are also being diagnosed with type 2 diabetes, ranging from 8 to 45% of cases reported. •The incidence is higher among: -older children -those who are obese -minorities. •Diagnosis: -Symptoms of diabetes plus a random (nonfasting) blood glucose level of 200 mg/dl or greater -fasting plasma glucose level of 126 mg/dl or greater -Or a 2-hour plasma glucose level of 200 mg/dl or greater during an oral glucose tolerance test diagnostic of diabetes -However, these criteria should be repeated on a different day to confirm results

Autism Spectrum Disorders (ASD) and Diet

•One of 5 disorders under the category of Pervasive Developmental Disorder •A complex developmental and neurological condition Usually evident by age 3 •People with ASD often have difficulty in talking, playing with other children, and relating to others •5 times more common in boys than girls •Cause of ASD remains unknown -Both genetics and environment are believed to play a role •People with ASD often repeat behaviors and have narrow, obsessive interests •For a variety of reasons, children with autism spectrum disorder (ASD) may not get the nutrition they need for healthy growth and development •Some children with autism will only eat certain foods because of how the foods feel in their mouths •Other times, they might avoid eating foods because they associate them with stomach pain or discomfort •Some children are put on limited diets (gluten-free or casein free) in hopes of reducing autism symptoms -•These types of behavior can affect eating habits and food choices, which can lead to the following health concerns: -Limited food variety could affect vitamin and minerals intake -Not eating enough food. Kids with autism may have difficulty focusing on one task for an extended period of time. It may be hard for a child to sit down and eat a meal from start to finish. -Constipation. This problem usually is caused by a child's limited food choices. It typically can be remedied through a high-fiber diet, plenty of fluids and regular physical activity. -Medication interactions. Some stimulant medications used with autism, such as Ritalin, lower appetite. This can reduce the amount of food a child eats, which can affect growth. Other medications may increase appetite or affect the absorption of certain vitamins and minerals. If your child takes medication, ask your healthcare provider about possible side effects. - -•Growth is usually normal •Research is limited, some various diet treatments have been tried: -Mineral and vitamin therapy -Elimination diets (gluten, casein) -Additional essential fatty acids -MegavitaminsPicky eating habits •Many parents find their child's sensitivity to tastes, colors, smells and textures the biggest barriers to a balanced diet •Getting a child with ASD to try new foods may be difficult and they may avoid certain foods or even entire food groups •This is generally a sensory issue, and can best be dealt with outside the kitchen. •Having the child be involved with the shopping and selection of a new food, researching it, and preparing it is an effective strategy to helping them become familiar with new foods in a low-pressure, positive way eventually help them become a more flexible eater.Make Mealtimes Routine •A child with ASD will have to work harder at mealtimes because a busy kitchen, bright lights and even the way the furniture is arranged all are potential stressors. •Making meals as predictable and routine as possible can help. •Serving meals at the same time every day is one of the simplest ways to reduce stress.

osteoporosis prevention

•Osteoporosis -Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. -As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps.•Loss of bone mass is normal and inevitable during adulthood •A large fraction of adult bone mass is acquired during adolescence •Prevention of osteoporosis depends in part on maximizing peak bone mass during young adulthood -Adequate nutrition -Regular weight bearing activity -Normal endocrine function

Aromatic Amino Acids and Inborn Errors of Metabolism

•Phenylalanine MetabolismPhenylalanine is an essential amino acid used for tissue protein synthesis and hydroxylation reactions that result in the formation of tyrosine. • •Hyperphenylalaninemia primarily affects the brain tissue. •The high concentration of phenylalanine interferes with the transport of the amino acids tyrosine and tryptophan into the brain. •Tyrosine is needed to provide energy and to synthesize protein, catecholemines, melanin, and thyroid hormones

assessment of growth development

•Serial measurements of height and weight are plotted on growth charts from the National Center for Health Statistics and are used to evaluate growth -height-for-age -weight-for-age -weight-for-height - •Height growth potential is calculated from parental height.•Height and weight are used to calculate BMI (kg/m2) •BMI for age growth charts -"At risk for overweight" defined as: •BMI greater than or equal to the 85th percentile less than the 95th percentile -Excessive weight in adolescents defined as: •BMI greater than or equal to the 95th percentile -Underweight defined as BMI less than 5th percentile

branched chain amino acids and inborn errors of metabolism

•The branched-chain amino acids (BCAAs) are: -Leucine -Valine -Isoleucine •The primary role of BCAAs is incorporation into body proteins •In newborns 75% of BCAAs are used for the synthesis of protein •BCAAs are an important source of nitrogen for the synthesis of nonessential amino acids