G&D 3

1. Metabolic factors acting during critical periods of growth in pre- and postnatal development can induce lasting effects on health and disease risk later on.

2. Serious short/long-term adverse effects on quality of life, health, life expectancy, financial burdens, stigma, etc.

3. Permanent reduction of body size

4. Associated with later adverse health outcomes like hypertension, increased overweight, increased body fat deposition, and increased risk of diabetes

1. Weight gain in first 24 months of life

2. Formula-fed

3. Yes

4. (1) Differences in feeding behavior (suckling pattern, frequency of meals, longer time intervals bt meals)

(2) Milk is variable in nutrient content from day to day unlike formula to fit child's needs

(3) Breastfeeding may enhance emotional bonding bt mother & infant

1. Formulas has higher energy density, differences in protein supply, differences in nutrient content

2. High protein supply in postnatal period increases body fat by enhancing secretion of insulin and IGF-1 and decreasing HGH secretoin (less lipolysis)

3. High protein content of formula predisposes infants to increased obesity risk later on in life

4. Passed as a result of severe health consequences when artificial breast milk failed to include key vitamins and minerals in new formula

1. Protein content (30-40% casein and 60-70% whey, while bovine is 80% casein and 20% whey), oligosaccharides, lower in fat than formulas

2. Ratio of sulfa-containing AAs differ greatly between the two (cysteine & methionine) & lower aromatic AAs (phenylalanine), also BM has taurine while CM (Cow milk) doesn't.

3. Key roles in immune system, protein synthesis, microbiome, and absorption/metabolism of other nutrients. LIMITED ABILITY TO SYNTHESIZE

4. Increased whey allows for small, soft curds --> easily digested.

1. Important energy source --> critical for formation/functioning of nervous tissue and cognitive functioning. Derived from linoleic and linolenic acids.

2. Prostagalndins, EGF, etc.

3. Immunoglobulins - high [IgA] esp in colostrum, passive immunity, lymphocytes, macrophages, lactoferrin (iron), etc.

1. Taurine

2. Major energy source, enhances Ca2+ absorption, ready source of galactose for brain, important for CNS development

3. Prevents adhesion of pathogenic bacteria by acting as receptor analogues, competing with epithelial ligands for bacterial/viral binding.

4. (1) energy source (2) protects against viral infections and parasites (3) major substrates for somatic & CNS development

1. (1) Rooting: stroke baby's cheek --> turns head towards stroked cheek and opens mouth to find nipple (2) Sucking: to permit feeding, a baby sucks when object is placed in mouth (3) Coordination of swallowing and breathing

2. 3x birthweight. Has greatest energy needs per ounce during this time.

3. Bc of human biped gait and brain size (1) Brain size increased to accommodate intelligent behaviors/language (2) biped gate altered structure of female pelvis from being rounder to wider.

Solution: deliver fetus at decreased levels of maturity

Adaptation: breast milk complements and offsets immaturity of newborn by secreting bioactive components, but cow milk lacks these factors bc there's no evolutionary pressure on cow to develop them.

1. Yes, 7% in BMI

2. Colostrum and breast milk neutralize propensity toward excessive inflammation and contain many immunological substances. Allows for proliferation of bifidobacteria.

3. breast milk - major energy source for brain.

1. Zinc (high in colostrum but low later on), fluoride, vitamin D - should be supplemented

2. Introduce foods one at a time, with rice/cereal/veggies introduced first.

3. Vit A, copper, IRON, zinc, B1, B3, and should be diverse to provide new taste/sensory experiences

4. Popcorn, juice, honey, grapes, hard candy, gum, hot dog pieces, etc.

1. Lower "pressure to eat" and higher "restriction" scores.

1. The push for higher overall consumption or just "healthy foodS" - promotes eating beyond satiety teaching children to ignore satiety cues.

2. Restrictive feeding - limits child's intake of unhealthy/snack foods. Children will consume more of previously restricted food than they would have otherwise.

3. Food avoidance behaviors

4. Parent is responsible for providing/serving food on a regular schedule, deciding when and where. Child is to decide whether to eat and how much.

1. Protein, Iron (Vit C for Iron absorption), Calcium (vit D for absorption), and monopolyunsaturated fat for brain growth.

1. (1) Neuroendocrine cues

(2) neurological/neuronal response

(3) reward systems (brain)

(4) recognition of tastes and odors

(5) diff organs systems functioning

Physiological - sympathetic nervous system, parasympathetic nervous system (3 cranial nerves to send signals to digestive system)

Neurodevelopmental: (1) gross motor skills (2) fine motor skills (3) control level arousal (4) sensory ability

• 16-20 --> amniotic fluid
• 18-24 suckling
• 34-37 coordinated suck and swallow
• birth - rooting reflex
• 6-8 months - sit, head control, closes lips over cup
• 10-12 pincer grasp

Genetic (sweetness, avoid bitterness)


Environment - physical activity, access to food/portion size, media, culture

Family/parents

• 1. 8-18 months
• 2. 9-12 months
• 3. 18-24 months
• 4. 24-26 months

(1) No bottle bc prolonged use increases caloric intake, results in failure to thrive/obesity, iron deficiency, caviies

(2) Juice should not be had before 6 months of age - no fiber, results in diarrhea, dental cavities, overweight and underweight.

1. CDC and WHO

2. American Academy of Pediatrics - use WHO from 0-24 months and CDC standards from 2-19 years old.

BC WHO growth charts were done using exclusively breastfed infants and CDC is recommended after age 2 since WHO growth charts go until age 5.

1. Child-temperament (slowness, emotional eating, fussiness, can't tell satiety response)

2. Parent - feeding styles (food as reward, restriction, pressure to eat)

• -----
• 2. (1) Eating skills and experiences (2) food from diff food groups (3) intro of veggies and fruits (4) serving size.

1. Fat content of a toddler's diet from 1-3 years old sould be 30-40% of energy intake, all 5 food groups every day, decreases to 25-35% fat at 4 years.

• 2. Growth Hormone Triggers:
• Physiologic - exercise, stress, slow wave sleep, low glucose levels, fasting

Pathologic - ILs, low protein, T1D, liver cirrhosis

• 3. Inhibition of Growth Hormone Release
• Physiologic - hyperglycemia, high FFA, high GH, high IGF, REM sleep, age

Pathologic  - LDopa, obesity, hypo/hyperthyroidism

1. Adipose tissue -  Acute insulin-like activities (protein/lipo/glycogenesis), AA uptake and metabolism,

- Bone - osteoclast differentiation, osteoblast activity, increases bone mass, stimulates epiphyseal growth

Muscle - increased AA transport, N retention, lean tissue, energy expenditure.

Insulin-like activity, promote sulphation of cartilage, stimulate DNA synthesis, and cell multiplication.

IGF is lower in infancy when growing is fastest, highest in adolesence and decreases (age/sex dependent)

Boys increased rate of IGF (start at 5) as opposed to girls (start immediately until puberty)

• 1. Increase O2 consumption
• 2. Increase # of mitochondria/mit protiens
• 3. Increased ribosomal proteins and nuclear incorporation of RNA
• 4. Important for skeletal maturation
• 5. Necessary in fetus & infant for axonal and nerve cell body growth in CNS.

• 1. Inhibit DNA synthesis in liver, heart, skeletal muscle, kidney
• 2. Inhibit cell proliferation
• 3. Inhibit enzymes
• 4. Acutely enhance growth hormone release
• 5. Chronically inhibits GH release
• 6. Antagonizes growth hormone action

- Minimal impact on growth prior to puberty. Basically, (1) enhances GH secretion and (2) IGF-1 production and (3) increases skeletal maturation (linear bone growth and epiphyseal fusion and bone mineral)

Opposites: subcutaneous fat (estrogen increases)

Testosterone increases muscle, energy expenditure, decreases visceral fat

Estrogen determines bone mass accretion - regulates timing of growth spurts.

Used to predict growth trajectory relative to "average" population. Can be used to determine unhealthy growth patterns.

Limitations - data for growth trajectories are collected from specific cohort that's not necessarily the same ethnically, SES, etc.

1. Upper: lower segment should decrease (birth - 1.7, post-puberty - 0.9).

2. Arm span catches up to height

• Child - span < height
• Adolescent span = height
• Adult - span > height

• 1. Boy = (sum of parental heights + 13 cm)/2
• Girl = (sum of parental heights - 13 cm)/2

2SD for target height = +/- 10 cm


2. Exponential attenuation of absorbed photons at 2 energy levels resolving tissues into bone, lean mass, and fat mass. Advanatages - validated against carcass analysis in pigs, limitations - susceptible to measurement bias


3. BIA (measures of electrical resistance in body) Advantages: cross validated with TBW, DXA, and TBW. Limitations: estimates TBW which must be converted to fat-free mass. Precision may be less than skin folds.

• 4. Skin-folds/anthropometry (uses multli-compartmental model of body comp with sum of skinfolds to predict total fat mass). Advantages - easy to use, appropriate for population-based studies, inexpensive.
• Limitations - sensitive to inter-user variability

Bone mineral content - tend to have higher mineral content than girls after puberty, both increase at same age, but higher in boys

Lean body mass - girls increase lean body mass at early age maxing at 15. Boys increase rapidly around puberty and then increase to a max much higher than girls

% body fat - boys maintain a level average of ~10% at all times. Girls continually increase body fat % as they age.

• 1. Subject to interobserver variation
• 2. Current US standard developed on American white children bt 1931-1942
• 3. Based on normal children - relevance to pathological conditions is unclear.