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Nutrition in Children and Youth

Dagmar Schneidrová Department of Child and Youth Health 3rd Faculty of Medicine Charles University in Prague. Nutrition in Children and Youth. Nutrition and Health. Childhood and adolescence = key periods for growth and development

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Nutrition in Children and Youth

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  1. Dagmar Schneidrová Department of Child and Youth Health 3rd Faculty of Medicine Charles University in Prague Nutrition in Children and Youth

  2. Nutrition and Health Childhood and adolescence = key periods for growth and development Ensure daily energy and nutrients requirements for health, growth and development and health in adulthood Inadequate intake of nutrients (esp. 0-2 years ) might cause irreversible changes

  3. Current Research Physiology: - nutrients relevant for metabolism and development of brain, intestinal flora and bones Epidemiology: - nutrient intake, eating habits, attitudes in preschool, school children - prevalence of nutrition related disorders (obesity, eating disorders)‏ Public Health, Health Promotion Projects: - effectiveness of intervention programmes (in preschool, school children)‏

  4. Brain and cognition Most intensive development of NS in prenatal period and up to 3 years Decreased intake of energy and essential nutrients in first years – important impact on structural and functional development of CNS Relationship between the intake of some nutrients and cognitive functions studied in detail

  5. Iodine Important for synthesis of thyreoid gland hormones Prenatal iodine deficiency – impact on cognitive development (e.g.learning disabilities)‏ Less evidence on relationship between deficit in children and cognitive development

  6. Folic acid (vitamin B9)‏ B-group vitamins (B1, B2, B6, B9, B12) required for the synthesis of various neurotransmitters Folic acid deficiency – in early pregnancy – risk of neural tube defects 1996 – FDA – a flour supplementation programme in the USA reduced the incidence of malformations by 13%

  7. Fatty acids (omega 3, 6)‏ Omega 3,6 polyunsaturated fatty acids (DHA) – found in phospholipids in CNS (brain, retina)‏ Play a role in cognitive development Deficiency rare – neurological and visual disorders (esp. in premature infants)‏

  8. Iron Metabolism of neurons, cognitive functions and behaviour Iron deficiency: - impaired brain function: * poor spatial memoryin adolescents * cognitive performance, attention - impaired immunocompetence: * decreased resistance toinfections - anaemia

  9. Zinc Key role in growth of cells and CNS development Modulates the transmission of nerve signals Deficiency in prenatal and postnatal period: – malformations of NS Deficiency in childhood: - impact on cognitive and motor functions in vulnerable children

  10. Breakfast – short-term impact Breakfast – replenishes carbohydrate reserves after fasting overnight – beneficial effects on brain functions: * learning ability (attention, memorization) * performance at school * behaviour

  11. Intestinal flora (immunity)‏ 0-5 years – development of intestinal flora BM – important for the development of immune system (L. bifidus, growth factors, trans-oligosacharides), protection against infections, allergies IF ferments non-digestable carbohydrates (fiber), results in formation of short-chain fatty acids (SCFA) which provide colonocytes with energy

  12. Bone growth 0-2 years – very fast growth (esp.in length)‏ 11-13 years (prepuberty) – intensive bone mineralization - half the mass of calcium of the adult is laid down 9-14 years – the period of peak bone growth – adolescents acquire 25% of their final bone mass Intense bone turnover in children, who replace 50 to 100% of their skeletonin a year, compared to 10% in adults

  13. Bone growth The construction of bone outweighs its destruction – allows the bones to increase in length and get stronger Calcium requirement of children (3-8 years) per unit bodyweight are 2 to 4 times greater than that of adults Intake of calcium and phosphorus – Ca/P > 1 (cola beverages – P>Ca)‏

  14. Calcium deficiency Has no immediate direct impact on growth (cannot be identified by growth curves)‏ Main effect - reduces mineralization and results in a lower peak bone mass US study – children who were deprived of cow´s milk over a long period were more liable to experience fractures Spanish study – a significant inverse relationship between the prevalence of fractures amongst school children and the calcium content in tapwater

  15. Bone growth Calcium Phosphorus Fluoride Protein Vitamin D Vitamin A Vitamin K Vitamin C

  16. Osteoporosis prevention Nutritional status of mother in last trimester of pregnancy (highest accumulation of calcium)‏ Genetic factors (60-80 %)‏ Hormonal factors (puberty)‏ Nutritional factors(esp. consumption of dairy products and other food rich in calcium – see next slide)‏ Physical exercise(increases bone density)‏

  17. Food rich in calcium • Milk, dairy products (cheese, yoghurt) • Sardines, herrings, sea-weed • Poppy, sesame seeds • Molasses • Appricots, figs • Cabbage, savoy cabbage, Brussels sprouts, broccoli, pulses

  18. Multiple deficiencies (Fe, Ca, Zn, Mg, I, vit. B6, vit. C, folic acid)‏ Delayed growth and development Rachitis (infants)‏ Anaemia (6-24 months, puberty)‏ Delayed menarché in girls (eating disorders)‏ Decreased resistance to infections Fatigue, low mental performance Emotional disorders

  19. Nutrient intake in preschool children (Maříková et al., 2005)‏ Evaluation of average daily energy and nutrient intake in 91 preschool children from kindergartens in Teplice, German RDI used Adequate intake of Ca, Fe, vit. B1, B2, energy, fat (29.5% - increased saturated fatty acids)‏ Sign. increased intake of proteins (2.45 g/kg compared to RDI 0.9 g/kg )‏ Sign. decreased intake of vit. C (67% of RDI)‏

  20. Nutrient intake in school children (Brázdová et al., 2000)‏ Survey in a representative sample of 980 children (junior and senior school age) from CR - 24 hour recall and food frequency ques. (focused on dietary sources of vitamins and Ca)‏ Inadequate intake of vit. C (80 and 50% of RDI in junior and senior school age), vit. E (69, 60%), Ca (66, 54%)‏ Recommended : -increaseconsumption of vegetable, fruit and milk products - focus on nutrition education (food pyramid)‏

  21. Health promotion projects (methods recommended by MoH)‏ Children: A little pyramid („Pyramidáček“) – Health Institute Brno Fruits and vegetables 5 times a day– MF MU Brno Complex system of intervention in school catering – National Institute of Public Health Prague Let´s slim with Bumbrlínek – Health Institute Brno Let´s eat and live healthy – Health Institute Plzeń What is wrong and good for us – HI Plzeń We´ll be healthy in the 21st century – MF MU Brno Optimalization of physical activity in school children – Pedagogical FacultyLiberec

  22. A little pyramid („Pyramidáček“) – Health Institute Brno • Educational programmme for kindergartens - basics on healthy nutrition and promotion of physical activity • Curricula – teaching methods - play, competitions, fairy tales, stories, arts (e.g. food pyramid) • http://www.pyramidacek.cz

  23. Interactive Programmes in Nutrition Education Skálová L., Komárek L., Kernová V., Rážová J. National Institute of Public Health Centre of Health and Living Conditions

  24. Pyramid of Healthy NutritionProgramme for Children • Education programme for food choice • Set up a food pyramid • Set up a diet • www.szu.cz zdraví/pro děti

  25. Websites(education of parents, teachers, children, physicians, nurses)

  26. www.vyzivadeti.cz

  27. Manual for teachers on nutrition (Health promotion in schools)

  28. „Best school lunch“ (General Health Insurance Comp. Competition, CR)

  29. Obesity and overweight in children and youth

  30. EU Community projects Children, Obesity and Associated Avoidable Chronic Diseases • coordinator: European Heart Network, Brussel (CZ: Czech Heart Association srdce) • 2004 - 2007

  31. Prevalence of overweight childrenin 31 countries grouped by region 25 North America North America (South) Western Europe (South) Western Europe United Kingdom United Kingdom 20 (Southwest) Eastern Europe (Southwest) Eastern Europe Scandinavia Scandinavia (Central) Western Europe (Central) Western Europe 15 Overweight Prevalence (%)‏ Overweight Prevalence (%)‏ (Northwest) Eastern Europe (Northwest) Eastern Europe 10 5 0 Italy Malta Spain Latvia Wales Canada France Croatia Estonia Ukraine Finland Poland Austria Norway Greece Hungary England Sweden Scotland Portugal Slovenia Denmark Lithuania Germany Switzerland Netherlands United States Czech Republic Belgium (French)‏ Belgium (Flemish)‏ Russian Federation The former Yugoslav Republic of Macedonia Source: HBSC

  32. PERCENTAGE OF OVERWEIGHT AND OBESE CHILDREN Reference data: WHO and IOTF recommendationsAge 7 – 11 years Report of the International Obesity Task Force, 2004

  33. Overweight and obesity in adolescents (13 – 17 years)The International Obesity Task Force (www.iaso.org)‏

  34. Overweight and obesity in Czech adult populationInternational Obesity Task-Force, 2005 www.iaso.org BMI = weight (kg)/ height2(m)‏ 1 .Norm 18,5 - 24,9 2. Overweight 25 - 29,9 3. Obesity I 30 - 34,9 4. Obesity II 35 - 39,9 5. Obesity III 40 and more

  35. Obesity - etiology Genetic factors Metabolic factors Socioeconomic factors Nutritional habits Physical activity Multifactorial disease

  36. Obesity Genetic factors Hormonal factors Socioeconomic,psychological factors Eating habits (increased energy intake)‏ Physical activity (decreased – low energy output)‏ High blood pressure High cholesterol Diabetes (II type)‏ CVD tumors Risk of preliminary death in adulthood higher by 50-80%

  37. Prevention of obesity Excl.breastfeeding for 6 months and sustained BF until 2 years Monitoringof growth and nutritional status (preventive pediatric examinations –early detection) Educationof parents and children on: -healthy nutrition and eating habits(regular eating regimen in smaller portions, healthy composition of a diet - food pyramid), warning about dieting- regular physical activity(balance between energy input and output)‏

  38. Nutritional Counselling (HPH – Health Promoting Hospitals/WHO)‏ Evaluation of history data, incl. weight (questionnaires) Assessment ofeating habits andfood consumption(24 hours recall)‏ Assessment ofphysical activity(questionnaires)‏ Analysis of data (PC programme – energy, nutrient intake)‏ Individual counselling based on current guidelines on healthy nutrition (food pyramid)

  39. Treatment of obesity Group weight reduction courses for children and parents, adolescents (STOB – www.stob.cz)‏ Health promotion projects of MoH (e.g. „Let´s slim with Bumbrlínek“)‏ Spa treatment

  40. Group weight reduction courses (www.stob.cz)‏ 3 months courses for children and parents/grandparents, adolescents Cognitive behavioural approach – modified for children (plays, contests)‏ Elaboration of individual regimen of healthy eating and physical activity Evaluation of questionnaires before and after treatment (effectiveness)‏ Follow-up, controls

  41. www.hravezijzdrave.cz

  42. References • WHO/Nutrition – School-age children and adolescents: http://www.who.int/nutrition/publications/schoolagechildren/en/ • WHO/Global Strategy on Diet, Physical Activity and Health/Childhood overweight and obesity: http://www.who.int/dietphysicalactivity/childhood/en/

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