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به نام یگانه آفریننده زیبایی ها ...

به نام یگانه آفریننده زیبایی ها . تغذیه در سنین شش تا بیست وچهارماهگی دکتررویا کلیشادی استاد دانشکده پزشکی، مرکز تحقیقات رشد و نمو کودکان دانشگاه علوم پزشکی اصفهان مهر 1392. Produced by: Dr.Roya Kelishadi. Total deaths around the world: 58 million. Total deaths around the world:

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به نام یگانه آفریننده زیبایی ها ...

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  1. به نام یگانه آفریننده زیبایی ها ...

  2. تغذیه در سنین شش تا بیست وچهارماهگی دکتررویا کلیشادی استاد دانشکده پزشکی، مرکز تحقیقات رشد و نمو کودکان دانشگاه علوم پزشکی اصفهان مهر 1392

  3. Produced by: Dr.Roya Kelishadi

  4. Total deaths around the world: 58 million

  5. Total deaths around the world: 58 million Deaths from noncommunicable diseases around the world: 35 million

  6. Total deaths around the world: 58 million Deaths from noncommunicable diseases around the world: 35 million Deaths from noncommunicable diseases in developing countries: 28 million

  7. Total deaths around the world: 58 million Deaths from noncommunicable diseases around the world: 35 million Deaths from noncommunicable diseases in developing countries: 28 million Deaths from noncommunicable diseases in developing countries which could have been prevented: an estimated 14 million

  8. Reduced capacity to care for baby Inadequate foetal nutrition Lifecycle: the proposed causal links Epigenetic susceptibility to chronic diseases if diet becomes inappropriate Higher mortality rate Impaired mental development Baby Elderly Weaning Inadequate growth Low Birth Malnourished Untimely / inadequate Weight Frequent infections Inadequate food, health & care Inadequate food, health & care Child Stunted Woman Reduced mental capacity Malnourished Pregnancy Low Weight Inadequate food, health & care Adolescent Gain Stunted Adapted from James et al. SCN Millennium Rep. Food & Nutrition Bulletin, 2000, 21, 3S. Higher maternal mortality Reduced mental capacity Inadequate food, health & care Prof. Philip James’ Lecture, Tehran 2008

  9. Reduced capacity to care for baby Disordered foetal nutrition Child overweight Adolescent O/W-obese The impact of inappropriate Western diets on most of the world's susceptible populations: health systems already overwhelmed Diabetes, strokes, heart disease, cancers arthritis Fat Baby Early Weaning Elderly Normal/high growth High Birth Untimely / inadequate Weight Frequent fast foods Rapid weight gain Inadequate physical activity Inadequate health care system Abdominalobesity Woman Reduced play and social isolation o/w or obese Pregnancy Glucose intolerance/ diabetes Poor school conditions Reduced fertility; CVD, HT Cancers Adapted from James et al. SCN Millennium Rep. Food & Nutrition Bulletin, 2000, 21, 3S. Early onset Type 2 Diabetes Reduced job opportunities Inadequate obstetric care Prof. Philip James’ Lecture, Tehran 2008

  10. اهمیت • پديده جهش رشد در دوران کودکی و نوجوا ني كه درادامه روند رشد اوايل زندگي روي مي دهد ٬ نيازفرد به انرژي و مواد غذايي را افزايش مي دهد. نیازهای غذايي درطي دوران نوجواناني بسیار بیشتر از سايردوران های زندگی است . با توجه به همبستگی تغذيه با رشد و تکامل ٬ تغذيه بهينه شرط لازم و ضروري براي كامل شدن پتانسيل روند رشد است .

  11. کمبود های غذایی و مصرف ناكافي مواد مغذی مورد نياز در اين دوران مي تواند منجر به تاخير روند رشد و بلوغ جنسي شود . • همچنین٬ تغذيه مناسب در اين دوران مي تواند به پيشگيري از بيماري هاي مزمن غیرواگیر دوران بزرگسالي از جمله بيماري هاي قلبي عروقي ٬ برخی بدخیمی هاو استئوپروز كمك كند .

  12. سلامتي دوران بزرگسالي مستلزم سلامتي دوران کودکی و نوجواني است . • پيشگيري و اصلاح اختلالات تغذيه اي براي تامين روند مناسب رشد و تكامل ضروري است. • از سوي ديگر ٬دوران کودکی و نوجواني زمان مناسبي براي اصلاح رفتارها و مشكلات تغذيه اي است كه در اوايل زندگي در حال شكل گيري بوده و تا سال ها بعد تداوم مي يابد كه به نوبه خود٬ در پيشگيري و به تاخير انداختن بيماري هاي مزمن وابسته به تغذيه در دوران بزرگسالي از اهميت زيادي برخوردار است .

  13. اختلالات شایع تغذیه ای در دوران کودکی ونوجواني • كمبود ريز مغذي ها و املاح معدنی • عدم تعادل در میزان دریافت انرژی و درشت مغذی ها • سوﺀتغذيه و کوتاهی قد • اضافه وزن و چاقي • پيروي از رژيم هاي غذايي خيلي محدود به دليل تصور نادرست از تناسب قد و وزن • گرايش به غذاهاي آماده و ميان وعده هاي غذايي كم ارزش از نظر مواد مغذي

  14. Prevalence of underweight in 6-year-old Iranian children,2007(n=899,035)

  15. Prevalence of oerweight in 6-year-old Iranian children,2007(n=899,035

  16. علت • كيفيت و كميت نامناسب مواد غذايي • عدم رعايت اصل تعادل و تنوع در تهيه غذاي خانواده • آگاهي ناكافي کودکان ٬ نوجوانان و اعضاي خانواده در زمينه نيازهاي تغذيه اي دوران رشد • گرایش به مواد غذایی با ظاهر جذاب و فاقد ارزش غذایی کافی

  17. Complementary Feeding • Transition from exclusive breastfeeding to family foods • Typically covers the period from 6 to 18-24 months of age, and is a very vulnerable period.

  18. Appropriate complementary feeding is: • Timely • Adequate • Safe • Properly- fed

  19. Nelson textbook:أٍTABLE 42-2 -- Important Principles for Weaningأ

  20. FEEDING DURING THE 2nd 6 MO OF LIFENelson textbook • By 4–6 mo of age, the infant's capacity to digest and absorb a variety of dietary components as well as to metabolize, use, and excrete the absorbed products of digestion is near the capacity of the adult. Moreover, teeth are beginning to erupt, and the infant is more active and beginning to explore his or her surroundings. With the eruption of teeth, the role of dietary carbohydrate in the development of dental caries must be considered as well as the long-term effects of inadequate or excessive intakes during infancy and the psychosocial role of foods during development. These considerations, rather than concerns about delivery of adequate amounts of nutrients, are major factors underlying the feeding practices advocated during the 2nd 6 mo of life.

  21. Infants should start receiving complementary foods at 6 months of age • Feeding frequency: 2-3 times a day: 6-8 months 3-4 times a day: 9-11 months 3-4 times a day with 1-2 snacks: 12-24 months

  22. Increase food consistency and variety as the child ages • Feed mashed and semi-solid foods, softened with breastmilk, beginning at 6 months of age. • Feed energy-dense combinations of soft foods to 6– 11 month olds • Introduce "finger foods" beginning around 8 months of age • Make the transition to the family diet at about 12 months of age

  23. Nelson textbook • Cereals, a good source of iron, are usually introduced 1st, followed by vegetables and fruits, then meats, and finally, eggs. However, the order in which these foods are introduced is not crucial, but only 1 new food should be introduced at a time and additional new foods should be spaced by at least 3–4 days to allow detection of any adverse reaction(s) to each newly introduced food

  24. Practice responsive feeding • Feed infants directly and assist older children when they feed themselves • Offer favorite foods and encourage children to eat when they lose interest or have depressed appetites • If children refuse many foods, experiment with different food combinations, tastes, textures, and methods for encouragement • Talk to children during feeding • Feed slowly and patiently and minimize distractions during meals • Donot force children to eat

  25. What factors influence food choices, eating behaviors, and acceptance?

  26. Sociology of Food • Hunger • Social Status • Social Norms • Religion/Tradition • Nutrition/Health • Food Choices • Availability • Cost • Taste • Value • Marketing Forces • Health • Significance

  27. Foods for infants and young children • Nurturing • Nourishing • Learning • Supports developmental tasks • Relationship • Development • Emotion and temperament

  28. Stages of Development: Neurophysiological

  29. Feeding developmentGessell A, Ilg FL

  30. Relationship • Feeding is a reciprocal process that depends on the abilities and characteristics of both caregiver and infant/child

  31. Relationship • The feeding relationship is both dependent on and supportive of infants development and temperament.

  32. Infant and Caregiver Interaction • Readability • Predictability • Responsiveness

  33. Play, Learning, Exploration

  34. FEEDING DURING THE ٍُSECOND YEAR OF LIFENelson Textbook • By the end of the 1st year of life, most infants will have adapted to a schedule of 3 meals/day plus 2 or 3 snacks. Although considerable latitude in the diet of each infant should be permitted to allow for personal idiosyncrasies and family habits, the caregiver should be given an outline of the basic daily dietary needs. Equally important, the caregiver should be aware of what to expect in terms of eating behavior as the child matures.

  35. REDUCED FOOD INTAKE • The rate of growth decreases toward the end of the 1st year of life, and the child's intake, accordingly, also decreases or fails to increase as rapidly as it did during the 1st year of life. It is not unusual for the child to have temporary periods during which he or she is not interested in certain foods or, indeed, in any food. Failure to expect and recognize these changes in eating behavior often results in attempts to force-feed. The parents should be reassured that the lack of interest in food is probably temporary and that attempts to force-feed not only are futile but also are likely to result in more severe feeding problems.

  36. SELF-SELECTION OF DIET • Children's strong likes or dislikes of particular foods become apparent after approximately 1 yr of age, and if possible and practicable, they should be respected. For example, the virtues of some foods (spinach) that are nonessential have been overemphasized, and conflicts about such foods should not be allowed to occur. Often a food that is refused when it is first offered will be accepted when it is offered again a few days or weeks later. On the other hand, if basic staples, such as milk and cereal, are consistently rejected, food allergy should be considered. If this is not a problem, alternative forms of these basic staples (cheese, yogurt, breads) should be offered.

  37. Food Pyramid

  38. MyPlate • MyPlate is divided into sections of approximately 30 percent grains, 30 percent vegetables, 20 percent fruits and 20 percent protein, accompanied by a smaller circle representing dairy, such as a glass of milk or a yogurt cup.

  39. كمك به والدين براي مقابله با رفتارهاي پر خطر در ارتباط با تغذ یه كودكان و نوجوانان

  40. Fetal Hypothesis Four potential fetal phenotypes may predict adult morbidities: • Thin babies may have insulin resistance in utero, and this continues after birth; • Short babies with reduced abdominal circumference may have raised LDL cholesterol; • Short and fat babies may develop non-insulin- dependent diabetes; • Those with a large placenta are at risk for hypertension.

  41. Thrifty Genotype The fetal origin hypothesis states that poor maternal nutrition programs the fetus and produces reduced birth weight and subsequent adult onset diseases. This suggests that such programming occurs during a critical or sensitive period in early fetal life. Studies have confirmed a relationship between poor maternal diet and blood pressure in offspring.This genotype is highly prevalent in Asians

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