CHILDHOOD AND NUTRITION

SCHOOL YEARS : AGES 5 TO 10 INFLUENCES ON NUTRITION IN CHILDHOOD CHILDHOOD DIET AND HEALTH UNDERNUTRITION IN CHILDHOOD PLANNING A HEALTHY CHILDHOOD DIET

SCHOOL YEARS AGE 5-10

NUTRITION AT SCHOOL
SCHOOL LUNCH PROGRAMS SCHOOL LUNCH PROGRAMS
School lunch and breakfast programs contribute significantly to nutrient intake School age children begin to make of their own food choices

US Department of Agriculture in 1946 Child Care Food Programs >95 % US public school participate in school lunch program

Meals must meet established nutritional guidelines, lunch --third of the RDAs for all nutrients, and breakfast must include milk, fruit or vegetable juice, bread, cereal Meals served at reduces price or free (income less than $1500/y)

School Lunch Programs Benefit

Providing nutritious food

Provide education in nutrition healthy food

choices Parents and children involved in menu planning Providing school lunches offering several food choices, programs can increase variety & allow student to participate in a healthy diet. Children tend to have higher nutrition intake & eat great variety of foods Children shows improvement in learning Programs are now encouraged to keep salt & sugar content at moderate
levels & reduce fat & cholesterol levels AHA recommendation

EATING PATTERNS IN OLDER CHILDREN

Appetite & food preferences are more predicrable

Increasing activity steady appetite

Differences intake male & female : male eat more

protein & micronutrients than female Fat intake : 35-40 % of total cal, sugar : 25 % cal (USDA 1987)
BREAKFA ST -Breakfast rebuilds glycogen stores depleted during the night and provide energy -10-30 % school aged children do not eat breakfast -Reasons : Not hungry, have no time, dont like food served, the foods they

INFLUENCES ON NUTRITION IN CHILDHOOD

PARENTAL INFLUENC ES
Evening meal: time for family interaction and socializing School aged children should help prepare in the meal plan & food preparation Mealtime criticism is not allowed reduce intake of certain vitamin especially vit A & C Parents should continue halthy eating habits carry into later life influence long-term health
TV affects children attitudes toward food and food preferences Advertisements Excessive TV viewing : sedentary lifestyle and may contribute to obesity The risk of obesity correlate with the amount TV watched everyday (Dietz and Gortmaker, 1985) Higher cholesterol levels

THE IMPACT OF TV ON CHILDHOO D NUTRITION

So, how?

Families and schools encourage children to develop active, imaginatives

INDONESIA PMT AS
Kemendiknas Renstra 2010-2014 : PMT Anak

Sekolah Pendekatan penyediaan makanan tambahan dilakukan dengan cara memberikan makanan tambahan dengan kandungan minimal 300 kilo kalori dan 5 gram protein yang diberikan sebanyak 108 kali dalam satu tahun ajaran. Pendekatan pendidikan kesehatan dan gizi dilakukan secara formal, informal dan non formal. Program lain : UNICEF bkj sama dg Indomart mengumpulkan dana utk penanggulangan gizi anak

INFLUENCES ON NUTRITION IN CHILDHOOD

Behavioral changes may cause by : lack of sleep,

lack of physical activity, emotional state, desire for attention, anxiety, or other factors--- NUTRITIONAL FACTORS IS ALSO

INFLUENCES ON NUTRITION IN CHILDHOOD

SWEETENERS No convincing evidence that refined sugar or aspartame cause behavioral problems -Feingold Diet 1970 -Double blind study--- found no benefit -Small number of ADHD may benefit -Short term elimination- observe the respond - if no improvement, children should resume normal diet Over children consume caffeine : chocolate, ice cream, carbonated beverage Effects : inattentive, restless, difficulty sleeping, irregular heartbeats

ARTIFICIAL FLAVORS & COLORS

CAFFEINE

VITAMIN & MINERAL SUPPLEMENTATION

Use of vitamin & mineral suppl among school-

aged children is extensive (Kover 1985) AAP 1993 : doesnt recommend routine suppl for healthy children Fluoride suppl is indicated for certain areas where drinking water contain less fluoride Suppl only for children with special conditions (TABEL 7.14 PAGE 421)

VEGETARIAN DIET
BENEFIT : plan-based diets supplemented with

milk or eggs and milk similar nutritionally to diets containing meats; children raised on well balance vegetarian diets have demonstrated excellent health. rarity of obesity lower blood pressure

VEGETARIAN DIET- NEGATIVE EFFECTS

May not provide adequate iron risk iron def anemia - Energy density of many vegan diet are low (ADA, 1988)

Inadequate energy or protein failure to grow Vegan children tend to be smaller

These diets are bulky young children may not able to consume adequate volume of food

Lack of calcium, zinc and iron for growing children; high in phytates inhibit the absorbtion of nutrient

SOLUTIONS FOR CHILDREN WITH VEGAN DIET

DIETARY IRON --- eat ample nuts, seeds and

legumes, in addition to milk and eggs Plants protein must properly combined to ensure the adequate intake of Amino Acids for growth Intake of vegetable oils and fortified soy milk Generous intake of unrefined cereals, legumes, seeds, and dark green leafy vegetables --- to avoid def Ca, Fe, Zn Fortified margarines to provide additional vit D AAP recommend the inclusion of multivitamin suppl with iron and vit B12

DENTAL HEALTH
Diet is also important in the prevention of dental

caries. Plaque on the tooth surface contains several strains of bacteria able to break down dietary sugar produce lactic acid dissolves the enamel, leads to cavity formation progress the cavity will deepen and allow bacteria to invade the dental pulp, causing infection, swelling and pain.

DENTAL HEALTH
Tooth decay occurs when a susceptible tooth is

expposed to cariogenic bacteria & sugar Cariogenic sugar : sucrose, glucose, maltose, lactose, & fructose Reducing the number of times sugar is introduced into the mouth will reduce the acid challenge to the enamel Restrict the sugar intake is important Protective factors against caries : fats and protein Fats can coat the teeth, reducing the cariogenic bacteria to produce acids, rduce the retention and cariogenicity of sugar Protein : increases the buffering capacity of the

DIETARY FAT AND CHOLESTEROL

Atherosclerosis appears to begin early in life and

progress in life and progress slowly into adulthood. Elevated cholesterol levels in childhood role in the initiation and development of atherosclerosis, and high total and LDL-cholesterol are correlated with the extent of early atherosclerosis in adolescents. Experts have recommended a strategy that combines 2 complementary approach : 1. Population-wide reduction in fat and cholesterol in the diets of all children 2. An individual approach aimed at identifying and treating children who are at greatest risk of having high blood cholesterol and an increased risk of cardiovascular disease in later life

 The guidelines for individual screening of children

only for children who have a parent whose cholesterol level is greater than 240 mg/dl, or a family history of early ( less than 55 years of age) heart disease. Children who have an elevated LDL-cholesterol AHA Step-One diet 3 months careful adherence to this diet fail to achieve goal AHA Step-Two Diet under qualified supervision because this diet requires stringent reduction of saturated fat and cholesterol intake ( saturated fatty acids : less than 7% of total calories; cholesterol less than 200 mg/dl ) careful planning to ensure adequate intake of all necessary nutrients.

 There have been concerns about safety of

implementing a lower-fat diet during childhood. Reducing fat intake while maintaining normal calories and protein will not lead to deficiencies of iron and calcium or other micronutrients. Another controversy surrounding cholesterol levels in childhood is whether high levels during childhood predict elevated levels in later life. A growing consensus of experts recommends the AHA Step-One Diet for children over 2 years old and adolescents. Many think if this diet could be adopted during childhood and carried into adulthood, it would reduce the incidence of cardiovascular disease and may prevent a variety of other chronic conditions and disease of later life.

FOOD ALLERGIES IN CHILDHOOD

Early childhood is a common age for food allergies

occur in 2 - 15 % of young children , particularly with family history of allergy. Environmental factors during infancy and exposure to antigens in early infancy may increase the risk of developing food allergies. Food allergies occur when dietary proteins are incompletely broken down before absorption, allowing large molecules of protein to enter the body and interact with the immune system. The immune cells identify the food molecule as an antigen and react by producing antibodies, histamine and other defensive compounds, and cause a variety of symptoms including anaphylactic reactions to food. Food allergies occur more often in early childhood than later in life because the developing intestinal tract and immune system are immature and inexperienced in

 Allergy to single foods is much common than to

multiple foods, can be immediate or delayed up to 24 hours. The preferred way to test for food allergy elimination diet. Food that most often provokes allergies are eggs, peanuts, fish and milk in 77% of cases; beef, pork, shellfish, peas, cocoa beans, hazelnuts, mustard in 12,8% of cases; and chicken, rabbit, garlic, soybeans, sunflower, carrots, almonds, peaches, bakers yeast and wheat four in 10,2% of cases. Children often grow out of food allergies. A study in 1987 found that over of children no longer reacted to the foods they had been allergic to previously.

LEAD POISONING
In the US, elevated levels of lead in the blood are a

major health risk for children-- decrease intellectual performance and produce other adverse health effects. through contaminated soil and water, LEAD PIPES, DISHES, ACIDIC FLUIDS A primary source of lead exposure, particularly on urban areas, is lead-based paints: eating paint chips, dust, dirt Children absorb more lead and are more sensitive to its effects than adults. Lead is absorbed and distributed much like calcium. Deficiencies in protein, iron or calcium enhance the absorption of lead and may increase its toxic effects in children.

 interferes with cellular enzymes and metabolism

slow growth, damage hearing, and impair

coordination and balance chronic lead intoxication may be listless and irritable low levels of lead exposure in childhood can impair neuropsychological development and classroom performance. AAP now recommends : lead screening when they are 9 12 months old and again at 2 years.

Iron deficiency
In many developing countries, a mostly cereal diet

with little meat, fish and ascorbic acid is low in bioavailable iron Intestinal parasites are common as a frequent cause of increased blood loss and iron deficiency Iron deficiency may cause anemia, decreased performance and impaired mental and motor development, have poor appetites, more likely to develop infections, and grow more slowly than their healthy counterparts Irondeficiency anemia is rare before 4 to 6 months of age, because the healthy infant has ample iron stores at birth Iron deficiency develops between 6 months 3 years if increased needs for rapid growth are not met by and adequate dietary supply. AAP recommendation : children up to age 3 should

Undernutrition in Children

Causes : Poverty, economic, social, cultural and

educational factors contribute to the problem Weaning an infant at an early age without a nutritious replacement for breast milk Infections are a major contributor to morbidity and mortality in the malnourished child--- diare malabsorbtion UNDERNUTRITIONgrowth retardation, decreased resistance to infection and disease, impaired learning ability, and increased mortality, contributing cause in 1/3 of all child deaths worldwide.

PROTEIN ENERGY MALNUTRITION

MILD - mildest and most common form of PEM is growth failure alone. -Growth impairment, most often seen in the post-weaning period from 9 months 3 years of age --Mild PEM in children increases the risk of infections(DIARRHEA, measles), mortality --functional impairment and diminished work capacity in adult life.

SEVERE

-Kwashiorkor occurs when a child consumes a diet with adequate energy but with a very low protein : energy ratio. -Children -- will not grow, and they develop anorexia, diarrhea, and characteristic hair and skin changes, edema is a hallmark of kwashiorkor, Subcutaneous fat may be preserved and, with edema, may mask the wasting of underlying tissue -- Severe muscle wasting often result in the childs being unable to stand or walk. -MARASMUS : form of severe PEM caused by starvation-inadequate intake of energy, protein and other nutrients results in a shrunken, wasted child. Body weight is less than 60% of expected weight for age. -MARASMUS :severely anemic, suffer from chronic infections, and have a high mortality.

 More often than either syndrome alone, severely

malnourished children develop characteristics of both kwashiorkor and marasmus. The term marasmic kwashiorkor is used for children who are less than 60% of expected weight and have edema and other signs of kwashiorkor. Treatment for severe PEM consists of providing adequate amounts of both calories and protein and treating intercurrent infections

MICRONUTRIENT DEFICIENCIES
1
often associated with protein-energy malnutrition significant adverse effects on growth, learning ability, and the immune system. micronutrient deficiencies, particularly of vitamin A and iron, play major roles in childhood stunting in certain developing countries micronutrient deficiencies were associated with widespread retardation of cognitive, motor and psychosocial development in children.

2 3

VIT A DEFICIENCY
Xeropthalmia : damage to the eyes from lack of

vitamin A Deficiency also impairs immunity : increase susceptibility to infection, increase mortality HIGH RISK : - Preschool-age children (1-6 years old) are most susceptible to vitamin A deficiency - Diets that are mainly vegetarian, with staple such as rice or cassava, and that lack dark green Strategies for preventing deficiency involve modification of diets to include : vegetables and yellow fruits, will be deficient in more sources of vitamin A, food fortification ( such as sugar in Central vitamin A. America and monosodium glutamate in southeast Asia), and distribution of
high doses of the vitamin to young children every three to six months.

IODINE DEFICIENCY
HIGH RISK GROUP :

- areas where the soil and water, and therefore the food produced on it, are low in iodine - adequate iodine in the diet, but the food supply contains substances that inhibit iodine absorption and metabolism (goitrogens), include cassava, soybeans and cabbages. - young children and pregnant women, when iodine requirements are high Two most common syndromes are goiter and cretinism

 The effects of iodine deficiency are particularly

severe for the fetus and growing child. Iodine deficiency associated with neurological damage, impaired mental function and retarded physical development. The most widely used and effective means of controlling iodine deficiency are fortification of salt with iodine and widespread oral or injected administration of iodinated oil.

MASALAH GIZI ANAK INDONESIA

RISKESDAS 2010 : 14 % balita gizi lebih >15 tahun prevalensi obesitas : 19,1 % tidak ada perbedaan prevalensi balita gizi lebih pada keluarga termiskin (13.7%) dan keluarga terkaya (14.0%) prevalensi balita gizi kurang 19,9 % 35,7 % anak Indonesia tergolong pendek PROGRAM PENANGGULANGAN MALNUTRISI ANAK : - PMT AS, DETEKSI ANEMIA PADA ANAK SEKOLAH - PENYULUHAN, KADARZI, UPGK