Nutrition in Childhood through Adulthood

1. Nutrition in Childhood through Adulthood

2. We discussed basic concepts of nutrition: - Food choices and nutritional guidelines - Digestion - Carbohydrates, lipids, and proteins - Energy balance and body composition - Vitamins - Water and mineral balance We then discussed applications of those concepts to sports nutrition and to maternal and infant nutrition. Today we will move on to discuss nutrition from childhood through adulthood.

3. Infants World Health Organization recommendations: - 75% of infants breastfed initially - 50% of infants breast feeding at 6 months • - breastfeeding for at least the first 2 years. • - breast milk or formula should be supplemented • with solid food beginning at 4 to 6 months.

4. Infants Since this breastmilk will be the infant’s only source of nutrition for many months, and a subtantial part of her nutrition for up to two years, it must contain all of the essential nutrients: - carbohydrates - lipids, including essential fatty acids - proteins, including essential amino acids - vitamins - minerals - water

5. Infants Since this breastmilk will be the infant’s only source of nutrition for many months, and a subtantial part of her nutrition for up to two years, it must contain all of the essential nutrients: - carbohydrates - lipids, including essential fatty acids - proteins, including essential amino acids - vitamins - minerals - water It also contains antibodies and immune cells to help the infant resist infections, and compounds which are natural laxatives.

6. Infants In some cases the mother either can not breastfeed her infant or chooses not to. There are a number of infant formulas available which are designed to provide adequate nutrition. Most of these use cows’ milk as the base, although some use soy compounds or other liquids. While adequate for most infants, they can not completly mimic the contents of breastmilk.

7. Most infants are ready to being eating solid foods by the age of about 4 to 6 months. - They can sit with the head upright, minimizing risk of choking - They lose the extrusion reflex of the tongue and can use it to move food from the front to the back of the mouth where it can be swallowed - Their intestines and pancreas are producing enough of the necessary digestive enzymes - They can drink enough liquids to maintain hydration Infants

8. Infants By six to eight months most infants can grasp “finger foods”. Within a year, most infants can begin self-feeding with a spoon. At this point most foods are appropriate.

9. Infants By one year of age, most children need about 850 to 1,000 kilocalories per day, nearly half of what they will require as adults. Their need for carbohydrates and proteins are, pound for pound, much higher than they will ever be again as they get older.

10. Children At about one year of age, the infant’s rapid growth slows down and will remain moderate until the next rapid growth period begins during puberty and adolescence. Their nutritional needs also slow down

11. Children As long as the child eats a variety of healthy foods she or he should get the necessary nutrients. Of particular concern are vitamin D, vitamin E, iron, and zinc, although all of the micronutrients should be monitored. Supplements can be used for children with special needs such as those who are ill or who have food allergies causing them to avoid certain foods, but these should be used cautiously to avoid overdoses.

12. Children “As long as the child eats a variety of healthy foods”, of course, is much easier said than done. Most children develop food preferences and avoidances, often influenced by advertising, typically preferring sweet or salty foods and avoiding many fruits and vegetables (just watch the commercials on TV shows designed for kids!) Prepared foods like fast-food burgers/hot dogs/fries/tacos/chicken etc, pizza, or desserts are high in fats, sugars, and/or salt.

13. Children “As long as the child eats a variety of healthy foods”, of course, is much easier said than done. Visit any school lunch cafeteria: the pizza, cookies and chocolate milk are eaten but most of the vegetables and fruits are thrown away.

14. Children “As long as the child eats a variety of healthy foods”, of course, is much easier said than done. At any children’s parties the staples are prepared foods like pizza or hamburgers, cake, ice cream, candy, and carbonated soft drinks.

15. Children “As long as the child eats a variety of healthy foods”, of course, is much easier said than done. According to the National Soft Drink Association (NSDA) the average person consumes over 600 12-oz servings (that’s 900 gallons) per year. More than 90% of elementary school aged children (5-11 years old) average at least 12 oz per day.

16. Children Obviously, ensuring good nutrition in childhood is difficult, with problems occurring at the two extremes: - Undernutrition / malnutrition - Overnutrition leading to obesity

17. Children – Undernutrition & Malnutrition In the United States, more than 12 million children grow up in households called “food insecure”: > 3,000,000 do not have enough to eat They are deficient in calories and in most nutrients > 9,000,000 consume enough calories but are deficient in specific nutrients. complex carbohydrates protein vitamins and/or minerals

18. Children – Undernutrition & Malnutrition Worldwide, more than 20,000,000 children under the age of five suffer from severe undernourishment. Nearly 6,000,000 children die from undernourishment each year – half of all child deaths.

19. Children – Undernutrition & Malnutrition “Malnourished children have lowered resistance to infection; they are more likely to die from common childhood ailments like diarrhea and respiratory infections. For those who survive, frequent illness saps their nutritional status, locking them into a vicious cycle of recurring sickness, faltering growth and diminished learning ability.” United Nations International Children’s Emergency Fund (UNICEF)

20. Children – Undernutrition & Malnutrition In the United States, a number of public and private programs attempt to help meet the nutritional needs of children: - School breakfast and lunch programs - Women, Infants, and Children (WIC) - Supplemental Nutrition Assistance Programs (food stamps) - USDA Child and Adult Care Food Programs (CACFP) - Food banks

21. Children – Overnutrition & Obesity At the other extreme is childhood obesity 20% of US children aged 1–11 are obese. 30 years ago this was only 7%. The percentage of adolescents aged 12–19 who are obese increased from 5% in 1980 to more than 18% now.

22. Children – Overnutrition & Obesity Obesity is a problem of both nutrition and physical activity “Positive Energy Balance” results when energy intake exceeds energy output At the same time that obese children are taking in too many calories, usually in the form of fats, many of them are also deficient in protein, vitamins, or minerals.

23. Children – Overnutrition & Obesity Most obese children are eating unbalanced diets - Highly processed foods - Fewer fruits, vegetables, legumes, seeds, nuts, whole grains - High in sugars - Low in complex carbohydrates - High in saturated fats - Low in polyunsaturated fats - High sodium - Deficient in iron, calcium, zinc, other minerals

24. Children – Overnutrition & Obesity Obese children are at risk for a number of conditions: - Diabetes - High cholesterol - High blood pressure - Early heart disease - Poor bone growth - Muscle weakness - Early sexual maturation

25. Children – Overnutrition & Obesity Obese children are at risk for a number of conditions: - Diabetes - High cholesterol - High blood pressure - Early heart disease - Poor bone growth - Muscle weakness - Early sexual maturation Obese children also often face increased social and psychological problems.

26. Adolescence As children get older and enter adolescence, they enter a period of rapid growth and sexual maturation which causes changes in their nutitional needs. On average, the most rapid period of growth occurs between the ages of 10 and 12 in girls and between the ages of 11 and 14 in boys, but there is a lot of variation in when this occurs in different individuals.

27. Adolescence Growth is typically linear at first, with growth of the bones of the limbs and vertebrae causing increases in height. Girls typically grow most rapidly just before menstruation starts (“menarche”) and reach 90-95% of adult height by then. Boys typically continue to grow taller for about two more years than girls, reaching 90-95% of adult height as they become sexually mature.

28. Adolescence As linear growth (height, limbs) slows down, growth of body mass (weight) continuesas bones thicken, muscles get larger, andconnective tissues are formed. This growth of bone, muscle, and other tissues requires significant amounts of additional protein, calcium, phosphorus, sodium, potassium, iron, and many vitamins as well as additional calories.

29. Adolescence .

30. Adolescence Diet and exercise are both important for normal growth - Healthy weight gain ages 12 – 18 years 30 - 40 lbs for girls 50 - 60 lbs for boys - Changes in body composition - Boys age 12: 13-23% body fat age 18: 10-20% body fat - Girls age 12: 16-29% body fat age 18: 17-31% body fat

31. Adolescence - Obesity As noted before, obesity is a major problem in adsolescents as well as in younger children: The percentage of adolescents aged 12–19 who are obese has increased from 5% in 1980 to more than 18% now. At the same time they are taking in too many calories, usually in the form of fats, many obese adolescents are also deficient in protein, vitamins, or minerals.

32. Adolescence - Obesity Most obese adolescents are eating unbalanced diets - Highly processed foods - Fewer fruits, vegetables, legumes, seeds, nuts, whole grains - High in sugars - Low in complex carbohydrates - High in saturated fats - Low in polyunsaturated fats - High sodium - Deficient in iron, calcium, zinc, other minerals

33. Adolescence - Obesity They are at risk for the same conditions as obese children: - Diabetes - High cholesterol - High blood pressure - Early heart disease - Poor bone growth - Muscle weakness - Early sexual maturation

34. Adulthood At about the age of 17 to 18, growth slows down as the individual finishes puberty and adolescense and enters adulthood. This is a period of relatively stable body composition and nutritional needs, which we discussed in the first half of this course.

35. Adulthood Many adults are able to maintain healthy eating habits and physical activity levels and stay relatively healthy for many years.

36. Adulthood Many adults are able to maintain healthy eating habits and physical activity levels and stay relatively healthy for many years. Other adults develop unhealthy eating habits: high in prepared foods, low in fruits and vegetables; high in simple sugars, low in complex carbohydrates; high in saturated fats; high in sodium; deficient in vitamins and minerals. Many become physically inactive.

37. Adulthood This sets the pattern for healthy or unhealthy eating patterns and exercis habits as these individuals move into older ages.

38. Adulthood

39. Age-related changes: - Decreased physical activity - Add fat; lose lean body mass - Reduced muscle and skeletal strength - Decline in immunity - Decline in vision,hearing, taste, smell - Digestive changes: loss of teeth reduced acid secretion reduced motility decreased pancreatic & liver function Growing Older

40. Growing Older

41. Growing Older With aging, calorie needs decline somewhat if the individuals becomes less active, but remain high if they remain active. As always: a healthy diet is best - Fruits and vegetables - Complex carbohydrates - Polyunsaturated fats - Low sodium

42. Growing Older There are some specific dietary needs as we we get older: Vitamin D needed for bone health, calcium balance Reduced ability to absorb vitamin B1 Folate, B6, B12 may help reduce heart disease risk Calcium needed to mnimize bone loss Iron needed to maintain healthy blood cells Magnesium needed for normal metabolism & muscle health Zinc needed to help wound healing to maintain immunity

43. Growing Older Many older individuals have trouble getting enough protein in their diets:

44. Growing Older However, many individuals remain healthy and active well into their seventies and eighties, and occasionally even older: - Healthy diet - Exercise