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what is the challenge in childhood nutrition?
- To provide energy and nutrients for:
- maintenance needs
- proper growth and development
- long term health
- To establish healthy eating and activity habits
- To develop a healthy body image
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how does weight gain work for a baby?
- A baby x2 its weight in 5months
- x3 in a year
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how to transition diet in childhood according to the American Academy of Pediatrics (AAP)?
- Adapt a low ↓ fat diet from age 2-3
- Expect to decrease CVD as adults
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how to transition diet in childhood according to the according to the Canadian Paediatric Society (CPS)?
- childhood is transition
- Priority is G and D, and healthy eating pattern for the whole family
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what is the composition of breast milk?
- 55% FAT
- 39% CARBOHYDRATES
- 6% PROTEIN
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what is the recommended adult diet?
- 58% CARBOHYDRATES
- 30% FAT
- 12% PROTEIN
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how many children are overweight or obese in canada?
- 31% of children in Canada
- Childhood obesity --> adult obesity
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what is the recommended treatment for obesity?
- Grow into weight
- Less aggressive
- More positive approach
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what is the BMI percentile for at risk of overweight?
85-95%
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what is the BMI percentile for overweight?
95%
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what does a medical assessment of Overweight Adolescent include?
- Personal and Family history: BMI changes
- Social/Psychological history: Including tobacco use, depression, family dysfunction, eating disorders
- Physical Exam: Anthropometrics, waist circumference, skin folds, blood pressure
- Laboratory tests: Fasting glucose, cholesterol, liver enzymes
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what are the goal of therapy?
- Primary goal = Behavioural change
- Secondary goal = Weight maintenance (after a change in behaviour occurs)
- Resolve/ Improve medical complications
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what is the appropriate goal in weight maintenance/loss?
- BMI < 85th percentile
- 1st maintain baseline wight (grow into weight)
- Rate of weight loss = 1lb/month
- Maintenance after achieving BMI is important
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what are some recommendations for children?
- Min 60 minutes of moderate to vigorous activity: play time, physical activity (sports, activities)
- Mostly aerobic: Vigorous at least 3 days a week
- Muscle/bone strengthening: 3 days / week
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how to decrease energy intake?
- Variety and moderation: No counting calories, drink water (or skim milk), eat nutrient dense not energy dense, refer to Food Guide
- Involve the family: meals/goal planning/reinforcement
- Strategies how to handle eating out of home
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what are some complications of weight management programs?
- Too severe restriction of calories: lean body mass may be lost and linear growth may slow
- Preoccupation with weight may translate to self esteem issues
- Conflicts between fam and kid = go to therapist
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what are some additional treatment options for high risk morbid obesity?
- 1. Bariatric surgery
- BMI > 40
- Behavioural commitment necessary for long term success
- 2. Pharmacotherapy
- Trials underway but currently not approved for paediatric use (<16yrs)
- Behavioural commitment necessary
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what are some long term prevention methods in larger patient populations?
- Breastfeeding promotion
- Parent/child dynamics: "Parents to provide, a child to decide" approach
- Limit TV time
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what are some child mortality stats?
- 6,900,000 = number of children under age 5 who died worldwide in 2011
- Number of deaths = declined from nearly 12 million in 1990
- 19,00 children die every day
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what are the causes of death in children?
- Neonatal
- Pneumonia
- Diarrhea
- Malaria
- Measles
- HIV/AIDS
- Injuries
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what is acute Protein Energy Undernutrition (PEU)?
- Short term
- Wasting
- Low weight for height
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what is chronic Protein Energy Undernutrition (PEU)?
- Long term
- Stunting
- Low weight + height for age
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how do we classify Protein Energy Undernutrition?
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what is primary PEU?
- Malnutrition due to inadequate intake
- Poverty
- Low food supple
- Poor quality of food
- Reasons??
- Armed conflicts
- Political disturbance
- Natural disasters
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what is secondary PEU?
- Malnutrition due to a disease state
- More common in Canada
- Decreased ↘ intake
- Decreased ↘ absorption/utilization (due to changes in GI tract)
- Increased ↗ losses
- Increased ↗ requirement
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what is Marasmus?
- "Succesful" adaptation to PEM
- Infancy < 2 years
- Severe deprivation or impaired absorption of proteins, energy, vitamins and minerals
- Develops slowly
- Severe weight loss and muscle wasting, including the heart
- < 60% weight for age
- Anxiety and Apathy
- Good appetite is possible
- Skin and bones appearance
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what is Kwashiorkor?
- "Unsuccessful" adaptation to PEM
- 1-3 years old (weaning period vulnerable)
- Inadequate protein intake or infection
- Rapid onset
- Some muscle wasting, some fat retention
- 60-80% weight for age
- Edema and fatty liver
- Loss of appetite
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what is edema?
- Plasma proteins leave leaky blood vessels and move into tissues
- Proteins attract water (small proteins like albumin), causing swelling
- When pressure is applied to the swelling tissues, it leaves an indentation
- Adults with heart proteins: swelling of ankles
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what are the long term consequences of PEM?
- Decreased:
- Development (physical, social, cognitive)
- Adult productivity
- Reproduction
- Potential of the society as a whole
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what are the differences between successful and unsuccessful adaptation?
- Successful Adaptation
- Ex. Marasmus
- Integrated metabolic response to a change in environment conditions
- Maintains steady state within preferred range
- Fully reversible
- No loss in overall function
- Unsuccessful adaptation (Accommodation)
- Ex. Kwashiorkor
- More severe metabolic adjustment
- Changes are outside " preferred range"
- May not be reversible
- Loss of physiological function
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what are some infection found in PEM?
- Lack of antibodies
- Hb no longer synthesized - anemia
- Dysentery - Infection of the GI tract
- Fever
- Fluid imbalances (edema) - Heart failure, possible death
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how does rehabilitation work for PEM?
- Restore fluid and electrolyte imbalances
- Nutrition intervention must be cautious, slowly increasing protein
- Treat infections
- Programs should involve the local people
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what are some infection common with PEU?
- Diarrhea
- Pneumonia and other respiratory tract infections
- Urinary Tract infections
- Measles
- Tuberculosis
- Parasitic infections
- Also parasitic infections are associated with Fe and Vitamin A deficiencies
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what is cholera?
- Bacterial infection of the small intestine producing toxin
- Vomiting, Diarrhea, Electrolyte imbalance, dehydration
- 3-5 million people per year
- 100,000-13,000 deaths per year
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what are the consequences of PEM?
- Decreased:
- Development (physical, social, cognitive)
- Adult productivity
- Reproduction
- Potential of the society as a whole
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what is the double burden of malnutrition?
- Undernutrition:
- ↑ risk of childhood mortality
- Childhood PEU (plus iron, Vitamin A and iodine)
- Malnutrition is 34% of health care burden
- Over nutrition:
- ↑ risk of chronic disease
- 11% prevalence of obesity/overweight and growing
- Worlds largest % of Type 2 DM
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