Nutrition in Childhood and Adolescence
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Growing pains
Failure to Thrive
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Child falls behind on weight (and length/height) gain
Could be due to illness (food allergies, asthma) or abuse/neglect
Catch-up growth is possible with additional Calories/protein
Stunting vs. wasting
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Wasting--usually due to an acute problem (illness)
– Weight affected
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Stunting--due to chronic problem
– Length, head circumference (in under 3-yr-olds), and weight affected
Nutrients of concern in childhood
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Iron
Zinc
Vitamin D and calcium
Vitamin E
Lead: Still a toxic mineral of concern
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Found in (pre-1978) lead paint, contaminated soil, and some folk remedies
from Mexico
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Adversely affects iron status, mental function, and bone
Less problematic in children with adequate intakes of iron, calcium, and zinc
States will pay for early intervention to help children affected by lead
poisoning recover
Childhood obesity
A burgeoning problem
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What factors may be contributing to this epidemic?
Treating childhood obesity
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“Diets” are not the answer
Make the change as a family
– Increase activity
– Kick the fast food habit
– Get everyone involved in planning and cooking meals
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Monitor the growth chart, not weight loss
Another controversial issue
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Screening kids for high cholesterol
Earlier conventional wisdom
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National Cholesterol Education Program: start cholesterol screening at age 20
American Academy of Pediatrics: test kids when there is a family history of
heart disease under 55 yr of age, OR if parent has total cholesterol > 240
mg/dL
Newer studies (two from Nov. JAMA, one unpublished)
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Finland: risk factors measured in 12-18 yr olds in 1980 could predict thickness
of their carotid arteries (index of atherosclerosis) in 2000
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Bogalusa (LA) Heart Study: childhood cholesterol measurements predicted
artery thickness 22 years later
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North Carolina: 59% of 8-17 yr olds had one risk factor for heart disease; 28%
had ≥2 risk factors
What to do about this?
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Focus on reducing childhood obesity?
Screen all kids for high cholesterol($)?
Put kids with high cholesterol on drugs like Lipitor?
Put heart-healthy curricula in the schools?
Adolescent Nutrition
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“That kid must have two hollow legs, he eats so much”
The Pubertal Growth Spurt
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Begins around age 10.5-11 years in girls
Begins around age 12.5-13 in boys
Overweight/obese kids often hit puberty earlier than their skinnier classmates
Growth in height precedes weight gain
Height growth ceases when growth plates at ends of long bones “close” at
sexual maturity
Puberty, continued
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Boys acquire more muscle mass than girls; girls get more body fat
Increased secretion of sex hormones induces changes in both sexes
Nutrients of concern in adolescence
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Calcium and vitamin D
Iron
Calories (excess and deficit)
The teenaged athlete
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Make sure adequate fluids and calories are available
Pay attention to possible disordered eating or anabolic steroid use
Girls can be prone to stress fractures due to low calcium intake and the female
athlete triad
Growth charts and what they mean
Bulletin
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Children who eat ready-to-eat cereal on most days were 75% less likely to be
overweight
Study in December 2003 J Am Diet Assoc
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Eating habits of over 600 kids aged 4-12 tracked
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50% of kids in latter group were overweight
Children who had ≥ 8 servings of cereal in 2-week period had lower BMI than
children who ate ≤ 3 servings in 2 weeks
Cereal eaters consumed less fat & cholesterol, and more vitamin A, calcium,
iron, zinc, and several B vitamins
Influences on teens’ food choices
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Peer groups
Advertising
Discretionary income
Fitness concerns
Availability
Nutrition in Aging
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Keeping the cardiologist and the grim reaper away
The good news about aging
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Elderly are healthier than ever
More mobile and independent
Poor elderly (especially women) have a better safety net
The not-so-good news
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Elder care, especially in the last 12 months of life, consumes a great deal of US
health care budget
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Incidence of Alzheimer’s and other dementias will increase with increased
aging population
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The large number of drugs elders take can lead to increased interactions
between drugs and with nutritional status
A few age-related changes
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Resting metabolic rate decreases
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Lean body mass (muscle) decreases, body fat increases
Bone density peaks ~ age 30, then falls
– Declines sharply in women at menopause
Blood pressure increases
Some more age-related changes
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Reduced liver, kidney, and immune function
Gastrointestinal motility decreases
Taste acuity decreases
Cardiac output and blood volume decrease
Nutrient absorption (especially B12) decreases, due to reduced stomach acid
Even more changes
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Skin less able to produce vitamin D
Thirst mechanism and body temperature regulation altered
Psychological Impacts of Aging
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Stress, due to health and economics
Isolation
Depression
Dementia
Alcoholism--a hidden problem
A snapshot of elderly nutritional status, courtesy of the 3rd National Health &
Nutrition Examination Survey (NHANES III)
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Calorie intake is < RDA
Calcium intake is < AI of 1200 mg/day
Intake of total Calories, cholesterol, B12, and % Calories from fat decline with
age
Nutrient Needs (2002 DRI’s)
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Protein 0.8 g/kg
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Fiber--21 g/day for women, 30 g/day for men
Energy for “active” elderly
– Males 3067 Calories, Females 2403 Calories
– Reduce for sedentary or bedridden
Micronutrients of Concern
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Calcium and vitamin D
Vitamin B12
Folate and vitamin B6
Iron
Zinc
Magnesium
The Elderly Food Pyramid
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Published in 1999 by researchers at the Tufts/USDA Nutrition Laboratory
Has water at the base of the pyramid
The flag at the top is for supplementation of calcium, vitamin D, and vitamin
B12
Limits to shopping, cooking, self-feeding
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Inability to drive
Arthritis or osteoporosis
Dietary restrictions
Lack of desire, ability, or facilities to cook
Poor dental health
Poor vision
Shopping for one in a Sam’s/Costco world
Finances
Programs for Elderly
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Congregate meals program
Home-delivered meals program (“Meals on Wheels”)
Elderly Living Facilities
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Independent Living
Assisted Living
Skilled Nursing
Alzheimer’s Units