1
Q
Infancy
A
First year of life (birth-12 months)
2
Q
Early infancy
A
0-6 months
3
Q
Later infancy
A
6-12 months
4
Q
Newborn development
A
- hear and move in response to familiar sounds (exposed to mothers voice in utero)
- subtle cues for hunger and satiety
- strong reflexes, especially suckle and root, within hrs. after birth
- reflexes replaced by purposeful movement
5
Q
CNS development in newborns
A
- begins in utero
- CNS immature when first born
- evolves in complexity in first year
6
Q
Reflex
A
automatic response triggered by specific stimulus
7
Q
Rooting reflex
A
infant turns head toward the cheek that is touched
8
Q
Suckle
A
reflex causing tongue to move forward and backward
- sometimes triggered by smell of breast milk
9
Q
5 domains of development
A
- Motor
- Sensory
- Cognitive/mental
- Language and communication
- Social, adaptive, emotional
10
Q
Motor development
A
refers to ability to control voluntary muscle movement
- influenced by sensory system
- gross and fine
- crawl/turn over
- ability to focus
11
Q
Sensory development
A
refers to responding to information from environment
12
Q
Cognitive/mental development
A
refers to development of brain through interaction with environment
13
Q
Language and communication
A
refers to development of ability to communicate
- can’t express but can communicate very early
14
Q
Social, adaptive, and emotional development
A
refers to development of responding to other people, gaining a sense of their own abilities and relationships
15
Q
Development occurs…
A
in a predictable sequence like building blocks
- stages are interrelatable
16
Q
Intrinsic influence
A
refers to development of things you can’t necessarily see
- child’s health (nutrition)
- brain function
- temperament
17
Q
Extrinsic influence
A
factors such as family, environment, cultural norms
18
Q
The development of motor control starts with?
A
Head and trunk control then lower legs
- top down
- central to extremities
19
Q
Motor control development influences?
A
Ability to be fed, feed self and amount of energy expended
20
Q
Sensorimotor
A
refers to knowledge of world limited to sensory perception and motor activity
21
Q
For infants, the _____ is an important source of stimulation and pleasure
A
mouth
- allows development of cognitive skill
- sensorimotor skills
- develop ability to speak
- move tongue properly
- say words
22
Q
Feeding tubes in early infancy can interrupt…
A
Development and have long term negative consequences
23
Q
Digestive system development
A
- gut functional at birth (can digest fat, protein, simple sugars)
- 6 months required for GI tract maturation
- as infant ages levels of digestive enzymes expand
- speed of stomach emptying increases
- peristalsis becomes more consistent
24
Q
Feeding skills development
A
- infants born with reflexes and food intake regulatory mechanism
- inherent preference for sweet taste
25
Reflexes fade and infant begins to purposely signal wants and needs at?
4-6 weeks
26
Tongue moves side to side, teeth arrive, and can swallow pureed foods and hold bottle at?
4-6 months
27
Self feeding with hands or spoon, munching and biting skills, lumpy and chopped foods, drinking from open cup at?
9-12 months
28
Energy needs from birth to 6 months
108 kcal/kg/day
29
Energy needs from 6 to 12 months
98 kcal/kg/day
30
Energy needs for babies born prematurely
120 kcal/kg/day
31
Energy needs in first 6 months of life are...
higher per pound than any other time of life
| - supports so much growth and development
32
Factors that influence caloric needs for infant
- weight
- growth rate
- sleep/wake cycle
- temperature and climate
- metabolic response to food
- health status
33
Warmer climates nurse...
more
34
Growth spurts typically happen at
3 weeks and 3 months
35
Growth spurts does NOT signal...
a need for solid foods or formula if breastfeeding
36
Protein needs from birth to 6 months
2.2g/kg/day
37
Protein needs from 6 to 12 months
1.6g/kg/day
38
Premie protein needs if growth or digestion are not affected
1.52 g/kg
39
Premie protein needs required for preterm or recovery from illness
3.0 - 3.5 g/kg
40
Premie protein needs for extremely low birth weight
4.0 g/kg
41
Hydrolyzed protein or single amino acid formulas may be used for
preemies or sick infants
42
Fat needs from birth to 12 months
AI about 30 g/day
43
Infants need ____ for _____ development
cholesterol; brain
44
Breastmilk contains about ___% calories from fat
55
45
CHO needs from birth to 6 months
60 g/day
46
CHO needs from 6-12 months
95 g/day
47
Metabolic rate of infants is...
highest of any time after birth
| - related to rapid growth and high proportion of muscle
48
Fluoride for infants
supplement at 6 months unless provided with fluoridated water
49
Vitamin D for infants
breastfed babies need supplement of 400IU from birth until 1 year of age
50
Iron requirements for birth to 6 months
0.27 mg/day
51
Iron requirements for 6 months to 12 months
11 mg/day
52
Anemia is uncommon in infants because of:
- prenatal iron stores of mother
| - high bioavailability in breastmilk
53
Whole, reduced fat or skim cow's milk should not be used before...WHY?
9 months of age
| - iron deficiency anemia linked to early introduction of cow's milk
54
Health Canada infant recommendations
1. support breastfeed up to 2 years and beyond
2. no cow's milk before 9 months (unless whole milk)
3. complementary feeding to start at 6 months
4. gradually increase frequency of complementary feedings
5. no honey before 1 year
6. progress in textures gradually
7. allergens
8. consider food safety and choking hazards
55
Progress in textures
pureed --> lumpy -->mashed --> diced
| - lumpy foods offered no later than 9 months
56
No evidence that introducing any allergen has an increased risk of developing an allergy after
6 months
| - offer no more than 1 potential allergen at time and wait at least 2 days before introducing another
57
Foods that could choke infants
- popcorn
- peanuts
- raisins
- stringy meats
- gum and gummy textured candies
- hot dogs
- hard fruits or vegetables
58
Recommendations for 6 to 9 months
- increasing textured foods
- slowly increase amount based on infant's appetite
- should be eating 3 meals with breast/formula feeds
59
Recommendations for 9 to 12 months
- move towards diced soft foods
- increase texture to encourage chewing
- encourage self feeding and eating family foods
60
Expectations for 12 months
- general pattern of 3 meals and 3 snacks
- slow self weaning as increase solid food intake (about 2 milk feedings/day)
- solids increase in amount progressing towards table foods with some modification
61
Hungry feedings cues
- watches food being prepared
- reaches for food, spoon
- tight fists
- irritation if pace too slow or stops
62
Full feedings cues
- plays with food, utensils
- slows pace of eating
- turns away from spoon
- tries to get out of high chair
- stops eating
- spits out food
63
Why assess physical growth in infants?
Reflects:
- nutritional adequacy
- health status
- economic and environmental adequacy
64
How do we assess physical growth in infants?
- weight
- height/length
- head circumference
65
Infant/child weight and height must be interpreted in context of
age and gender
66
How do we interpret growth in infants?
percentile rankings
- child weighs the same or more than 95% of reference population
- child weighs less than 5% of reference population
67
Who is reference population when referring to percentiles?
WHO studied children from 6 countries:
Brazil, Ghana, India, Norway, Oman, USA
- based on standard measurements of babies
- based on an exclusively breastfed population
68
Difference between infant growth charts used in CA (WHO) and USA (CDC)
- CDC based charts describe how children have grown in past
| - WHO describe how children should grow
69
Interpretation of growth data
Measures over time identify change in growth progress and whether there is a need for an intervention
70
Warning signs for infant intervention
- loss of weight or length gain
- plateau in weight or length for > 1 month
- drop in weight without regain in a few weeks
- fast gain in weight
71
concern for underweight in infants
less than 3rd percentile for weight for age
72
concern of stunting in infant
less than 3rd percentile for height for age
73
concern of wasting in infant
less than 3rd percentile for weight for length
74
risk of overweight in infant
weight for length greater than 85th percentile
75
overweight infant
weight for length greater than 97th percentile
76
obese infant
weight for length greater than 99.9th percentile
77
small or large head for infant
head circumference less than 3rd or greater than 97th percentile
78
WHO charts can be used as growth indicator for premies only if...
infant's body weight is greater than 2500 g
79
For premies, catch up growth can take...
1-3 years
80
Using growth chart for premies need to correct
for gestational age
81
Correcting for gestational age
1. subtract gestational age from 40 weeks
2. divide by 4 to get months
3. subtract that amount from current age
82
What is the gestational adjusted age for a 9 month old infant born at 32 weeks of age
7 months
83
Low birth weight is...
- an indicator of general health of newborns
| - a key determinant of growth, health and development
84
Low birth weight infants are at...
greater risk of dying during the first year of life, and of developing chronic health problems
85
What percentage children less than 4 years of age have a food allergy?
6-8%
86
Common allergy symptoms in infants
respiratory or skin rashes
87
Treating allergies in infants
may consist of baby formula with hydrolyzed proteins
88
Food avoidance/postponement may lead to...
decreased nutritional adequacy and limit variety
89
___________ for infants at risk of allergies
Breastmilk
90
Oral tolerance induction
The idea of slow sensitization especially for milk, soy, egg and wheat
- overcome risk of allergy by consuming tiny but increasing portions of the food
- train immature immune system
- shown to help prevent certain allergies
91
Between the ages of 1 to 3 years
toddlers
92
Between the ages of 3 to 5
preschoolers
93
Toddler stage characterized by
rapid increase in gross and fine motor skills
94
Preschool stage characterized by
- increasing autonomy
- broader social circumstances
- increasing language skills
- expanding self control
95
Health Canada recommendations for young children
1. serve small nutritious meals and snacks each day
2. do not restrict nutritious foods because of allergen potential
3. offer variety form all 4 food groups
4. satisfy thirst with water
5. respect children's ability to determine how much food to eat
6. be patient
7. be a good role model
8. organize fun physical activities
96
Toddlers and preschoolers have small stomachs so
they need to eat small amounts of food more often throughout the day
97
Children need a total of ___ of milk every day to help meet their requirement of vit. D
2 cups
98
Equation for estimating energy requirements for 13 to 36 months
```
89 x (child weight in kg) - 100 + 20 kcal
- account for age, gender, height, weight, physical activity level
```
99
Most Canadian toddlers/preschoolers _______ recommendations
Meet or exceed
100
RDA for protein for children 1 to 3 years
1.1 g/kg/day
101
RDA for protein for children 4 to 8 years
0.9 g/kg/day
102
Most toddlers and preschool-age children have adequate vitamin and mineral consumption except for
- iron
- calcium
- vit. D
103
What nutritional factors put preschoolers at risk for iron deficiency
- high milk consumption
| - low iron diet
104
RDA for iron for children 1 to 3 years
7 mg/day
105
RDA for iron for children 4 to 8 years
10 mg/day
106
Approximately ____% of children aged 1 to 5 years have iron deficiency anemia in Canada
3.5 to 10.5%
107
Much higher iron deficiency anemia where in Canada and why?
Northern Ontario First Nation communities
- due to high consumption of evaporated milk and cow's milk at 6 months of age an prolonged breastfeeding without sufficient supplementation
- don't necessarily have access to good dietary sources
108
Iron deficiency anemia in children may cause
delays in cognitive development and behavioural disturbances
109
Preventing iron deficiency anemia in children
- limit milk consumption to 2 cups per day
- provide iron rich foods
- Canadian Task Force on Periodic Health Examination recommends that all high risk infants be screened at 6 and up to 12 months
110
Treating iron deficiency anemia
- iron supplements
- counselling with parents
- repeat screening
- micronutrient powders (sprinkles)
111
RDA for calcium for children 1 to 3 years
700 mg/day
112
RDA for calcium for children 4 to 8 years
1000 mg/day
113
Ensure adequate calcium intake in children through:
- milk and milk alternatives
- dark green vegetables
- fish with soft bones that are eaten
114
RDA for vitamin D for 1 to 8 years
600 IU
115
Approximately ___% of Canadian children deficient in vit. D
20
116
Feeding behaviours of toddlers
- rituals are common
- may have strong preferences and dislikes
- food jags are common
- imitate parents and siblings
117
May take up to how many exposures before toddler accepts food?
8 to 10
118
What is not a good way to get kids to eat vegetables?
- clean your plate
- using food as reward
- heavy restriction of less healthy
119
Development of feedings skills of preschool aged children
- can use fork, spoon, and cup
- temper tantrums occur less frequently
- foods should be cut into bite sized pieces
- adult supervision required
120
Beginning at age 3, DRI equations for estimating a child's energy requirements are based on child's:
- age
- height
- weight
- activity level
- gender
121
On average toddlers gain?
8 oz. per month
122
What percentage of children aged 2-5 are overweight/obese?
13%
123
On average preschoolers gain?
4 lbs. per year
124
WHO definition of obese children aged 2 to 5
BMI greater than 97th percentile for age and gender
125
WHO definition of overweight children aged 2 to 5
BMI greater than 85th percentile for age and gender
126
Toddlers and preschoolers should obtain ___ minutes of any intensity physical activity per day
180
127
Interpersonal and environmental considerations for toddlers and preschoolers
- child care
- neighbourhood environment
- family influence
- peers
- parenting style
- media
128
Parenting and feeding styles
- authoritarian
- indulgent
- neglectful
- authoritative
129
Authoritarian
control child eating, restricting food, forcing other food
130
Indulgent
minimal guidance/structure, child eats whenever and whatever
131
Neglectful
parenting is absent, foods available may be inadequate/inappropriate
132
Authoritative
balanced approach
- parent determines what is offered
- child determines what is eaten
133
Low warmth and high demandingness
Authoritarian
134
High warmth and low demandingness
Indulgent
135
Low warmth and demandingness
Neglectful
136
High warmth and demandingness
Authoritative
137
Authoritarian style parenting ___ times more likely to obese compared to authoritative
4
138
Indulgent and neglectful style parenting __ times more likely to be obese compared to authoritative
2
139
Canadian guidelines for screen time for children 0 to 2 years
No screen time
140
Canadian guidelines for screen time for children 2 to 4 years
under 1 hour per day
141
Each 1 hour increment in TV viewing associated with
- higher intakes of sugar-sweetened beverages, fast food, red and processed meat, total energy intake, and percent energy intake from trans fat
- lower intakes of fruit, vegetables, calcium, and dietary fiber
142
Marketing influence on child nutrition
- commercials during child programming
- fast food predominates sponsorship, even for ad free television
- characters, give aways
- child oriented food products
143
Goal for overweight and obesity in toddlers and preschoolers
maintain weight while increasing height
- weight loss typically not recommended (don't exceed 1 pound per month)
- not time to restrict food
144
Treatment guidelines for overweight and obesity in toddlers and preschoolers
Stage 1: prevention plus
- behaviour change and more frequent follow up
Stage 2: structured weight management
- planned diet/eating, logs to monitor behaviour, monthly follow up
Stage 3: comprehensive multidisciplinary intervention
- more intensive intervention, multiple health professionals, weekly follow up visits
145
What is nutrition screening?
- process of identifying characteristics known to be associated with nutrition problem
- completed by dietitians OR health care professionals in various settings
- determines the need for further nutritional assessment
146
Why nutrition screen?
- early identification of problems
- to prevent serious consequences in future
- to provide treatment when needed
- to identify who needs services, treatment and referrals
- to promote awareness and behaviour change
147
Nutrition screening tools
- contain measures/questions focusing on known risk factors
- usually short check lists
- nutritional risk increases with increased presence of risk factors
- categorizes individuals based on needs for further assessment
- MUST be followed up appropriately
148
What is NutriSTEP?
Nutrition Screening Tool for Every Preschooler
- 17 question screening tool for both toddlers and preschoolers
- each answer associated with a Risk Level
- parent administered
- determines 3 levels of risk
149
NutriSTEP provides:
- early identification of potential nutrition problems
- parent referral to community resources
- parental nutrition education
- support in evaluating preschool nutrition interventions
- means of monitoring community nutrition programs
150
Target behaviours in the prevention of overweight or obesity from birth would include:
- limiting sugary beverages
- encouraging consumption of fruits and vegetables
- limiting portion sizes
- eating a fibre-rich diet
151
Middle childhood
children between the ages of 5 to 10
152
Preadolescence for girls
ages 9 to 11
153
Preadolescence for boys
ages 10 to 12
154
Unique characteristics for school-aged life stage
- preparation for physical and emotional demands of adolescent growth spurt
- adequate nutrition associated with improved growth and performance
- girls develop earlier than boys
155
Cognitive development of school-aged life stage
- achievement of self efficacy
- developing sense of self
- more independent, learning role in family
- peer relationships become more important
- adequate nutrition associated with improved academic performance
156
Self-efficacy
knowledge of what to do and ability to do it
157
Physiological development of school aged life stage
- increases in muscular strength, motor coordination, and increased overall stamina
158
Boys general have more ______ ______ than girls
lean tissue
159
Adiposity rebound
In early childhood when body fat reaches a minimum then increases in relation to the body's preparation for adolescent growth spurt
160
When does adiposity rebound occur?
At about 6 years of age
161
Percent body fat reaches a minimum of __% in females
16
162
Percent body fat reaches a minimum of __% in males
13
163
Early adiposity rebound is associated with
increased obesity risk
164
Adiposity rebound tends to be ___ in females than males
earlier and greater
165
BMI considerations for school aged children
- BMI is not consistent because there is so much growth (weight and height) during this time
- plotting BMI for age intervals is really the only way to know where children stand
- goal is not to strive for certain BMI but to be in reasonable percentile based on age and gender
166
Protein DRI for children 4 to 13 years old
0.95 g/kg/day
167
AMDR
Acceptable Macronutrient Distribution Range
- the range of intake for a particular macronutrient source, expressed as a percent of total energy, that is associated with reduced risk of chronic diseases while providing sufficient amounts of essential nutrients
168
Wiggle room
AMDRs for children aged 4 to 18 years is not static there is 20% of wiggle room
169
Benefits of fibre
- provides fuel for beneficial bacteria within lower GI tract
- aids with waste removal
- slows digestion
- makes you feel fuller longer
170
Fibre is indigestible
- we cannot breakdown plant components ourselves
- cannot obtain energy
- no AMDR
171
Fibre recommendations for children aged 4 to 13
Between 25 and 31 based on age and gender
172
Canadian health survey for children aged 9-13 suggests...
- fat consumption is too high
- fibre intake is too low which is related to low fruit and veg intake
- calcium levels are low
- sodium is way too high
173
During childhood dietary iron and iron status are usually _______
adequate
174
Children at risk for iron deficiency
- limited access to iron-rich foods
- low iron or specialized diet (vegetarian)
- medical conditions that affect iron status
175
A child with a BMI equal to or greater than the 85th percentile but less than the 95th percentile is...
overweight
176
Toxic media environment
Kids these days are exposed to way too much screen time
177
Influences as you get into school age
- self esteem and body image in media
- more peer influences
- friends telling the truth
- anatomic toys
178
Weight based stigmatization exhibits as
- biased attitudes, prejudice and behavioural intentions
- various forms of discrimination
- social marginalization, weight-related teasing
179
Normal increase in body fat during school aged children may be interpreted as...
beginning of obesity before girls have growth spurt
180
Parental controls and restriction of forbidden foods may...
increase intake of these foods
181
Weight-related teasing associated with:
- increased frequent dieting
- increased extreme weight control behaviours
- increased binge eating
- increased depressive symptoms
- decreased self esteem
- decreased body satisfaction
182
Measures to prevent childhood obesity
- limit sugar sweetened beverages
- limit TV
- limit fast foods
- limit portions
- limit energy dense foods
- have daily breakfasts
- encourage fruits and veg
- promote calcium rich diets
- promotes diets high in fiber
- promote physical activity
183
What works for preventing childhood obesity?
Combination of clinical and school based multi-component programs
- physical activity
- parent training/modelling
- behavioural counselling
- nutrition education
184
Physical activity guide for children aged 5 to 17
- 60+ mins/day of moderate to intense exercise
- 3+ days/week, intense exercise
- 3+ days/week, muscle building exercise
185
Approximately what percent of Canadian children achieve 60+ minutes 6+ days/week
7%
186
_____ level of activity in school aged children compared to preadolescents
HIGHER
187
Schools are in a unique position to support healthy eating...why?
- reach nearly all children
- captive audience
- venue for both nutrition and education
- role modelling/social norms
- may have positive influences on parents
188
4 aspects of school nutrition environment
1. School food and beverage policy
2. Breakfast/snack programs
3. Access to off campus vendors
4. Health Curriculum
189
Ontario School food and beverage policy
- Nutrition standards for food and beverages sold in elementary and secondary schools
- Took effect in September 2011
- Applies to all venues and events on school property
- 10 "event" days per year where any food is limited
- 20 minutes of daily physical activity
190
Ontario School food and beverage policy nutrition standards
3 categories
- green
- yellow
- red
191
Green category
Sell most (at least 80%):
- healthier options
- higher levels of essential nutrients and lower amounts of fat, sugar and sodium
192
Yellow category
```
Sell less (less than 20%)
- may have slightly higher amounts of fat, sugar and sodium than food in green category
```
193
Red category
Not permitted
- foods contain few or no essential nutrients
- contain high amounts of fat, sugar and sodium
194
Green food examples
- extra lean ground meat
| - whole grain bread
195
Yellow food examples
- white bagels
| - cheese
196
Red food examples
- candy
- energy drinks
- fried foods
197
Chocolate milk controversy
- 250 mL has approximately 26 g of sugar and policy states that schools are not allowed to sell milk-based drinks with more than 28 g
- children like it!
- good source of calcium, vitamin D, protein
- 2 x the sugar of white milk
- no added health benefits
- normalization of sugary foods
198
How is the policy doing?
Not very well
199
Food breakfast programs
- Canada has no national breakfast program; education is the jurisdiction of provincial governments
- district school/level programs may provide "universal" breakfast, lunch, or snacks to children
200
Breakfast programs in Guelph
- Food and Friends
- Breakfast for Learning
- Breakfast clubs of Canada
201
Number of breakfast programs are _______
increasing
202
Canadian Children's food and beverage advertising initiative
- voluntary industry driven program
| - core principles include not advertising food or beverage products in elementary schools
203
Ontario Health Curriculum
Incorporates healthy eating component
- grade 1: Food groups, hunger
- grade 2: food choices, food guide
- grade 3: nutrition value, local and cultural foods, environmental impact
- grade 4: nutrients, healthy eating
- grade 5: food labels, media effect on choices
- grade 6: benefits of healthy food
- grade 7: health issues form food choices
- grade 8: macro/micro nutrient functions
204
How many minutes of physical activity per day are recommended for school aged children?
60 minutes
205
Early adolescence
11 to 14 years old
206
Middle adolescence
15 to 17 years
207
Late adolescence
18 to 21 years
| - crosses over with early adulthood
208
Adolescent nutritional needs
- substantial physical, emotional and cognitive maturation
- rapid physical growth affects nutrient needs
- strong desire for independence can influence food choices
209
Puberty begins during...
early adolescence
210
Biological changes of puberty include
- increases in height and weight
- sexual maturation
- changes in body composition
- accumulation of skeletal mass
211
___ of changes is consistent but ___ of changes is not
Order; timing
212
Sexual maturation
Biological age not chronological age
213
Sexual maturation should be used to
assess nutritional needs
214
Sexual maturation rating
scale to assess degree of sexual maturation
215
SMR stage 1
pre puburtal growth and development
216
SMR stages 2-5
occurrences of puberty
217
SMR stage 5
sexual maturation has concluded
218
Sexual maturation in boys
genital development and pubic hair growth
219
Sexual maturation in girls
breast development and pubic hair growth
220
Menarche
onset of first menstrual period
221
Menarche in girls occurs
2-4 years after initial development of breasts
| - SMR 4
222
Age of menarche in girls
ranges from 10 to 17 years
| - earlier now than in previous generations
223
Peak velocity of linear growth in girls occurs
approximately 6 to 12 months prior to menarche
| - SMR 3
224
Slow or delayed growth occurs
- in highly competitive athletes
| - severely restricted diets
225
___ tend to develop earlier than ___
Girls; boys
226
Peak weight gain in girls follows
linear growth spurt by 3 to 6 months
227
Girls decrease in lean body mass from __% to __% of body weight
80; 74
228
Girls gain approximately __ cm and stop growing around __ years of age
8; 16
229
Females experience a __% increase in body fat during puberty
120
230
Body fat levels in females
low: less than 20%
medium: 28%
high/obesity: greater than 35%
231
__% body fat is required for menarche to occur
17
232
__% body fat is needed to maintain normal menstrual cycles
25
233
In males there is a ______ variation in chronological age at which sexual maturation takes place
large
234
Peak velocity of linear growth in males occurs ____ and ends ___
during SMR 4; with the appearance of facial hair
| - can be as early as 10 years and as late as 14
235
Boys can gain between ____ cm/year in height
7 and 12
236
In males linear growth continues throughout adolescence at a slower rate until about
21 years
237
In males peak weight gain occurs
at the same time as peak linear growth
238
Peak weight gain for males is approximately ___ lbs. per year
20
239
In males body fat decreases to approximately __%
12
240
___ of bone mass is accrued in adolescence
Half
241
By 18 __% of skeletal mass is formed
90
242
Given growth and development during adolescence, what are the key nutrients?
- Calcium
- Iron
- Vit. D
- Protein
243
Energy requirements for adolescents are influenced by
- activity level
- BMR
- Pubertal growth and development
244
Level of activity ______ during adolescence
Declines
245
Energy ranges for male and female adolescents
Males: 2200 - 3100 kcal/day
Females: 2000 - 2400 kcal/day
246
Protein requirements for adolescents influenced by
amount needed to maintain existing and lean body mass and develops new muscle
247
DRI protein requirements for adolescents
0.85 g/kg (AMDR 10-30%)
248
Low protein intakes during adolescence linked to
- reductions in linear growth
- delays in sexual maturation
- reduced lean body mass
249
Carbohydrate intake for adolescents
130 g/day or 45-65%E
250
Dietary fibre recommendations for males and females age 9 to 18 are between
26 and 38
251
Fat required during adolescence
- required as dietary fat and essential fatty acids for growth and development
252
What is the AMDR for total fat and omega 3 fatty acids during adolescence?
25 to 35%, and 0.6 to 1.2%
253
Less than __% E from saturated fat
10
254
During peak weight gain, adolescent males gain an average of __ lbs. /year
20
255
Calcium AI during adolescence is critical why?
to ensure peak bone mass
256
Calcium absorption highest for females and males when?
around menarche and during early adolescence
257
Approximately how many times more calcium is absorbed during adolescence compared to adulthood?
4x
258
Adolescents who do not include dairy should consume...
Calcium fortified foods
259
RDA for calcium for ages 9 to 18?
1300 mg/d
260
Vitamin D important because?
- facilitates intestinal absorption of calcium (and phosphorus)
- essential for bone formation
261
Northern latitudes may require supplementation of what?
Vitamin D
| - synthesized by body via skin exposure to sunlight
262
DRI for vitamin D during adolescence
600 IU per day
263
Iron critical during adolescence because
- rapid rate of linear growth and increase in blood volume
264
Female iron needs highest _____
after menarche
| - 15 mg/day
265
Male iron needs highest ____
after growth spurt
| - 11 mg/day
266
Other key nutrients during adolescence?
- zinc
| - B vitamins
267
Why is zinc important during adolescence?
for sexual maturation and growth especially in males
268
Why are B vitamins important during adolescence?
for protein synthesis and cofactor properties
269
"teen" brain refers to
- ability to reason although rational thought may be limited
- living in the moment so limited consideration of long-term consequences
- reward benefits much more important than possible risk
270
Social and emotional development during early adolescence
- strong need for social acceptance from peers
- body image may change as a result of changes in body shape
- increased awareness of sexuality
- strong sense of impulsivity
271
Social and emotional development during middle and late adolescence
- increased opportunities for employment and outside activities
- greater autonomy from parents
- continued need for social acceptance from peers
- increased awareness of social and moral issues
272
About __% of adolescents report following a vegetarian diet
4
273
Reasons adolescents adopt a vegetarian diet include:
- cultural or religious beliefs
- moral or ethical concerns
- health beliefs
- to restrict fat/calories
- a means of independence from family
274
Compared to non vegetarians, vegetarians tend to have:
- higher intake of fruits and veggies
- less overweigh/obesity
- more eating disorders
- more weight controlling behaviour
275
Position of dieticians of Canada on vegetarian diets
- depends on level of restriction (high = concerns with adequacy)
- can be associated with eating disorders
- fortification and supplements will help vegans to achieve adequate nutrition
276
Teen eating challenges
- nutrition knowledge may be limited
| - may be motivated by weight loss
277
Physical activity guide for children aged 5 to 17
- 60+ minutes/day of moderate to intense exercise
- 3+ days/week, intense exercise
- 3+ days/week muscle building exercise
278
Rates of physical activity tend to ______ as children get older
decrease
279
Association between body satisfaction and weight related behaviours in females
Lower body satisfaction associated with:
- increased extreme weight control behaviours
- increased binge eating
- decreased physical activity
- decreased fruit and veg intake
280
Association between body satisfaction and weight related behaviours in males
Lower body satisfaction associated with:
- increased extreme weight control behaviours
- increased binge eating
- decreased physical activity
281
Continuum of eating concerns and disorders
Body dissatisfaction > dieting behaviours > disordered eating > clinically significant eating disorder
282
Key features of anorexia nervosa include
- refusal to maintain body weight at normal weight for age
- intense fear of gaining weight
- amenorrhea
- distorted body image
283
Key features of bulimia nervosa include
- recurrent episodes of rapid consumption of a large amount of food in a discrete period of time
- use of laxatives or diuretics
284
Binge eating disorder
Binge eating not followed by compensatory behaviours caused by dietary restrictions leading to uncontrolled hunger
285
Why are eating disorders so common in adolescence?
- life is overwhelming
- so many changes
- struggling for independence and identity
- increased pressure
- source of control over stress
286
Early adulthood
Mid 20s to 30s
287
Characteristics of early adulthood
- involved in transitions to adulthood
- planning, buying and preparing food may be newly developing skills
- may have renewed interest in nutrition
288
Midlife
40 to 64 years
289
Characteristics of midlife
- period of active family responsibilities
- managing schedules and meals becomes a challenge
- multigenerational caregivers
- health concerns are frequently added
290
Older age
65+ years
291
Characteristics of older adult
- transition to retirement
- more leisure time
- greater attention to physical activity and nutrition
- food choices and lifestyle factors especially for those with chronic disease
292
Physiological changes of adulthood
- growing stops by 20s
- bone density continues until 30 yrs. of age
- dexterity and flexibility decline
- muscular strength peaks around 25 to 30 yrs.
- decline in size and mass of muscle and increase in body fat
293
Hormonal changes in adult women
- decline in estrogen
- increase in abdominal fat
- increase in risk of CVD and accelerated loss of bone mass
294
Hormonal changes in adult men
- gradual decline in testosterone level and muscle mass
295
Body composition changes in adults
- positive energy balance
- increase in weight and adiposity
- decrease in muscle mass
- fat redistribution
- bone loss begins about age 40
296
Fat redistribution
- gains in central and intra-abdominal space
| - decrease in subcutaneous fat
297
Between ages 20 and 64, health and wellness greatly influenced by:
- diet
- PA level
- body weight
- smoking
298
Caloric intake declines by approximately __% per decade during early adulthood...due to?
2; decreased metabolic rate and decrease in physical activity
299
To maintain a healthy weight into adulthood
- consume nutrient-dense/lower energy foods
| - increase physical activity
300
It is difficult to meet vitamin and mineral needs at calorie levels below
1800
301
AMDR ranges for adults
Fat: 20-35%
Carb: 45-65%
Protein: 10-35%
302
Fibre helps:
- prevent against certain types of cancer and heart disease
- allows us to eat a lot more food
- helps rid body of cholesterol
303
Calcium RDA ___ to ___ mg/day for adults
increases; 1200
304
All adults over age 50 should take a supplement with ____ because:
400 IU of Vit. D
- limited exposure to sunlight
- institutionalization or long working hours
- certain medications
305
Most older adults are above adequate intake of what micronutrient?
Iron
306
Total body water ____ with age
decreases
307
____ glasses of fluid/day will prevent dehydration in most older adults
6+
308
Risk factors for health conditions in adults and older
1. overweight/obesity
2. weight pattern
3. waist circumference
4. Physical inactivity
309
Recommendations for PA in adults
- 30 to 60 minutes per day
- 150 minutes per week
- strength training twice per week
- start slowly 10 minutes at a time and build up tolerance
310
In adults and older adults weight bearing and resistance exercises increase
lean muscle mass and bone density
311
Chronic conditions with modifiable risk factors include:
- heart disease
- cancer
- stroke
- type II diabetes
312
What is the life expectancy in Canada?
82 years
313
Fastest growing population group in Canada?
Elderly
314
2 main causes of death
Cancer and heart disease
315
Lean body mass
sum of fat-free tissues, mineral as bone and water
316
Sarcopenia
term used for loss of LBM associated with aging
| - can begin as early as 40 years old
317
LBM decreases ___ from age 30 to 70
2-3% per decade
318
3 nutritional considerations for older adults
1. Sensory changes
2. Physical limitations
3. Cognitive factors
319
Taste and smell ___ with age
decline
320
_____ retain their sense of smell better than _____
Women; men
321
What affects taste and smell more than aging?
Disease and medications
322
Cognitive disorders
- Alzheimer's
- Vascular dementia
- Parkinson's disease
- Alcohol-related and AIDS-related dementia
- Dementia
323
Dementia
a progressive cognitive decline, characterized by forgetfulness, memory decline, difficulty with decision-making and mental ability
- ranks 5 in cause of death of older people
324
Effects of cognitive disorders
- confusion
- anxiety
- agitation
- loss of oral muscular control
- impairment of hunger/appetite regulation
- changes in smell and taste
- dental, chewing and swallowing problems
325
Nutrition interventions for cognitive disorders must:
- ensure food safety
- safe use of kitchen tools and equipment
- dietary focus
- nutrient-dense diet
- maintain hydration
- supply needed energy
326
Change in eating patterns that comes with aging
- meal prep
- decreased appetite
- smaller less frequent meals
327
Changes in sensual awareness related to appetite
hunger and satiety cues weaken
| - need to be more conscious of food intake levels since appetite regulating mechanisms may be blunted
328
Changes in sensual awareness related to thirst
thirst regulating mechanisms decrease with age
329
Older adult meal intake impacts:
- weight changes
- nutrient intake
- disease management
- immunity
- risk of falls
- psychological health
330
Factors impacting nutritional intake of older adults:
- disease condition
- functional disability
- inadequate food intake
- swallowing difficulty
- depression or anxiety
- poly pharmacy
331
Poly-pharmacy
- taking too many medications
| - certain medications limit absorption
332
Oral health depends on and determines?
```
Depends on:
- GI secretions
- Skeletal systems
- mucus membrane
- muscles
- taste buds
- olfactory nerves
Determines what we can eat
```
333
Strategies to promote food intake in older adults:
- maintain focus on eating
- provide plenty of time to eat
- serve favourite foods
- encourage regular drinks between bites
334
As adults get older milk and alternatives ____, fruits, veggies, and grains ____ and meat and alternatives ____
increases; decreases; remains the same
335
Nutrition concerns for older adults
- poor intake of all four food groups
- variety of nutrients consumed at low levels (vitamin C, D, folate, B6, B12, calcium, magnesium, and zinc)
- protein and energy also low
336
Osteoporosis
Porous bone
| - results from decreased bone mass and disruption of bone architecture
337
Osteoporosis ___ in women than in men
higher
- mostly due to hormonal changes
- decrease in estrogen for women
- men testosterone tapers more slowly
338
Osteoporosis symptoms
Osteoporosis has no symptoms
339
Of older people who break a hip:
- 10 to 20% die within a year
| - 50% have permanent disabilities
340
Kyphosis
shrinking height
| - results from compression or bone fracture in spine
341
Nutritional remedies for osteoporosis
- increase calcium and vitamin D through diet or supplements
- don't take calcium with antacids
- consume foods rich in vitamins C, D, B6 and K
342
Promise of Prevention and Health Promotion:
- good nutrition habits make a greater impact when started early in life
- never too old to practice health promotion strategies
343
Infant mortality includes
deaths that occur within first year of life
344
Which of the following statements best describes motor development in infants?
a. Voluntary control of muscles starts from head and moves down legs
b. Voluntary control of muscles starts from being able to fan toes out at birth to blinking eyes in response to loud noise or light
c. Voluntary muscle control develops with central muscles first and then moves out to hand muscles
d. Voluntary muscle control develops with rooting reflex and then moves out to hand muscles
e. a and c
e. a and c
345
Which of the following is a warning sign indicating growth problems in infants
a. Plateau in head circumference gain for more than one month
b. Lack of height gain
c. Plateau in gain for more than one month
d. Drop in weight without regain within a few weeks
e. All of the above
e. All of the above
346
Infants need a high fat diet compared to older people; therefore up to _____ of calories from fat may be recommended?
a. 25%
b. 32%
c. 40%
d. 55%
e. 60%
d. 55%
347
The 2006 WHO growth charts are based on longitudinal and cross sectional data of ________________.
a. Preterm and full term infants
b. Low birth weight and normal birth weight infants
c. Exclusively or predominantly breastfed infants
d. Formula fed infants
e. Infants fed equal amounts of formula and breast milk
c. Exclusively or predominantly breastfed infants
348
BMI in the 90th percentile would indicate that a 3 year old was:
a. Underweight
b. Normal weight
c. Overweight
d. At risk of overweight
e. Obese
c. overweight
349
Potential consequences of a weight loss program in childhood are slowed linear growth and the beginnings of an eating disorder
a. True
b. False
True
350
At daycare a small chocolate candy bar was given only to three year olds who ate everything at mealtime. Choose the best description of the feeding relationship problem between daycare center staff and 3 year olds:
a. Inappropriate portion sizes for toddlers
b. Served severely restricted junk foods
c. Inappropriately used coercion to control food intake
d. Taught children to like sweets
c. Inappropriately used coercion to control food intake
351
Preadolescence is generally defined as ages:
a. 5-10 for girls/7-9 for boys
b. 7 to 9 for girls/9 to 11 for boys
c. 9 to 11 for girls/10-12 for boys
d. 10-12 for girls/11 to 13 for boys
e. 11 to 13 for girls/12 to 14 for boys
c. 9 to 11 for girls/10-12 for boys
352
What are the proposed mechanisms by which television viewing contributes to obesity?
a. Reduced energy expenditure
b. More commercials advertising appropriate foods
c. Increased intake while watching television
d. All of the above
e. a and c only
e. a and c only
353
The most significant predictor of childhood obesity has been found to be:
a. Low family income
b. Food insecurity
c. Parental obesity
d. Lower cognitive simulation
e. Use of formula instead of breastfeeding
c. Parental obesity
354
The struggle for independence that characterizes adolescent psychosocial development may lead to development of health compromising eating behaviours, including:
a. Excessive dieting
b. Meal skipping
c. Use of unconventional nutritional supplements
d. Adoption of fad diets
e. All of the above
e. All of the above
355
Health advantages for an adolescent consuming a vegetarian diet include:
a. High intake of fiber
b. High intakes of B vitamins, especially B12
c. High intakes of vitamins and minerals found in plant foods
d. All of the above
e. a and c only
e. a and c only
356
During peak weight gain, adolescent males gain an average of ___ lb./year.
a. 10
b. 20
c. 30
d. 40
b. 20
357
Susan is a 15 year old who likes fruits some vegetables and breads but refuses to consume milk, seafood and eggs. A recent doctor visit revealed normal hemoglobin and plasma ferritin levels…what would you advise?
a. A folate supplement (400mg/day)
b. A vitamin D supplement (400 IU/day)
c. An iron supplement (10mg/day)
d. No changes in nutrient intake
b. A vitamin D supplement (400 IU/day)
358
Men and women continue to develop bone density until 40 years of age
a. True
b. False
b. False
359
Among adults, the AMDR for total fat intake is ____ of calories.
a. 10-15%
b. 15-20%
c. 20-35%
d. 35-40%
e. 40-50%
c. 20 to 35%
360
Which type of fiber is helpful in decreasing absorption of cholesterol?
a. Oatmeal
b. Viscous fiber
i. Soluble
c. Fermentable fiber
i. Insoluble
d. Potato skin
e. a and b
e. a and b
361
In older adults, BMI is an adequate indicator of excess body fat associated with morbidity and mortality.
a. True
b. False
b. False
NUTR 2050
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