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Nutrition

Zhang Dongmei
the department of pediatrics
the third affiliatted hospital of zhengzhou
university
I. The base of nutrition
Energy requirement
1.Basal metabolism measured at room
temperature 10-14hr after a meal ,with the
patient physically and emotionally quiet.

Fever : each centigrade increase 10%


Infant : 55kcal/(kg.d)
Maturity : 30kcal/(kg.d)
.
2. The thermic effect of food (TEF)
refer to the increase in metabolism over
the basal level by the ingestation and
assimilation of food.

• protein increase 30% above the basal level


• carbohydrate and fat (sparing effect)
increase only 4% and 6% respectively
 Infant 7%-8% of total caloric intake
 Older child <5% of total caloric intake
3. Energy required for growth
Positively correlate with the growth rate
• the first 6m 40-50 kcal/kg
• 6m-12m 15-20 kcal/kg
• toddlers age,preschool-age ,school-age
5kcal/kg.d
• adolescence increase
4. Physical activities
infant 15-20kcal/kg/24hr
12-13y 30kcal/kg
5. Elimination
Not more than 10% of the intake
Total energy requirement
neonate 1st W 60kcal/(kg.d)
2nd-3rdW 100kcal/(kg.d)
infant(baby) 110 kcal/(kg.d)
With subsequent decrease of about
10kcal/kg for each succeeding 3yr period.
15y 60kcal/(kg.d) approximate adult
The distribution of calories
• protein 10-15%
• Carbohydrate 50-60%
• fat 35-50%
ii. The resource of energy
• Each gram of ingested protein or
carbohydrate provides 4 kcal

• one gram of long-chain fatty acid provides


9 kcal.
1)Proteins

Functions :
• Supply amino acids ;
• Form hemoglobin,nucleoprotein,glycoprotein
and lipoprotein
• Form enzymes,antibodies;
• Form protective structures
1) Protein
 Protein constitutes 20% of adult body weight
 Its amino acids are essential in forming cell protoplasm
 24AA have been identified
 9 AA are essential for infants
(threonine, valine, leucine, isoleucine, lysine, tryptophan,
phenylalanine,methionine,and histidine)
 Arginine cystine and taurine are essential for low birth weight
infants
1) Protein
• ‘biologic value’ of proteins indicate effectiveness
of utilization
protein of high biologic value have the quantity and
distribution of essential amino acids appropriate
for resynthesis of body tissue and produce little
waste. - high-quality protein
biologic value of milk, eggs, meat,fish ,bean and
nuts are much high than cereals
The amount of protein required
• <1y 2-4g/kg.d adult 1.1g/kg.d
2) Fats
Functions
• Approximately 98 % nature fats are in form of triglycerides,
fat is the main energy stores in body and the most
concentrated source of energy in the diet
• Protect vital organ
• Provide essential fatty acid (EFA)
• Form cellular membrance
• vehicle for fat-soluble vitamines
The amount of fat required
<1y 4g/kg, >6y 2.5-3g/kg EFA 4-5% total energy
essential fatty acid (EFA)

• Conception :EFA such as linoleicacid or alpha- linolenic


acid can not be synthesized and must be supplied in the diet

• Functions :EFA are necessory for growth, skin and hair


integrity, regulation of cholesterol metabolism,lipotropic
activity, decreased platelet adhesiveness and reproduction.

• Disorder :Low linoleicacid develop dryness thickening


and desquamation of skin
essential fatty acid (EFA)
• arachidonic acid, ducosahenxenoic acid DHA are
metabolism production of linoleicacid or alpha- linolenic
acid respectively
They will affect the development of cerebral nervous
structures and retina in infants

• Nature source: plant oil


Dietary recommendations indicate that the ratio of
linoleic:linolenic acid=4-6:1
bean oil is the most ideal and balanced source of them
3) carbohydrate
Functions
• Supply most of body`s energy needs
• stored as glycogen in the liver and muscles
• Form glycoprotein and 糖脂 glucolipids
蛋白多糖 proteoglycan
requirement
<1y 12g/kg.d >2y 10g/kg.d
Infant the first months lack of 淀粉酶 amylolytic
enzyme
If it is supplied poorly,protein and fat will be
resolved
Disorder: diabetes, glycogen storage disease,etc.
4) Water
• Water content
newborn 80%, infant 70%, adult 55-60%

• Water requirement
Infant 150ml/kg.d, 9yr 75ml/kg.d
12yr 50ml/kg.d
decrease 25ml for each succeeding 3yr period
5) Vitamins
• Fat-soluble vitamins   A,D,E,K
• Store in liver and fatty tissue
• Deficences develop more slowly
• A greater risk for toxicity
• Water-soluble vitamins B , C
• Dissolve in water,eliminated in urine
• The danger of toxicity fewer
• Deficences develop more quikly
6) Minerals
• Major minerals
calcium,iron ,phosphorus, magnesium ,sodium,
chloride, potassium
• Trace elements,
zinc,fluoride,copper,iodine
7) Dietary Fiber
• Insoluble fibers
• Increase stool bulk and water content
• Influence mineral absorption
• Soluble fibers
• Bind bile acids and reduce lipid and cholesterol
absorption
• Pectin slow gastric emptying and the rate of
nutrients of absorption
II. Infant feeding
Breast feeding provides optimal nutrition for
the normal infant during the early months of life
1.Breast feeding
1.Colostrum (Time 1-5d after delivery)
• Total amount is 10-40ml low, alkaline
• protein and minerals highest
• Lower in carbohydrate and fat
• Contain some unique immunologic factors
2. transitional milk 6-10d
• fat highest
• lower in protein and minerals
3 .mature milk 11d-9mo
• lower in protein
• total amount highest
4 .late milk 10mo---
• lowest in total amount and nutritional
ingredient
Component of breast milk
1. protein
• a relativty low casein content
• a lot of a-lactalbumin and lactoferrin
• SIgA.
• Others: lysozyme,lipase,growth factor  
2. fat
• essential fatty acid
• long-chain unsaturated fatty acid
3. carbohydrate
lactose improves the development of lactobacillus
4. vitamin lack of vitamin K and D
5. mineral matter   low in calcium and iron
The ratio of calcium to phosphorus is 2:1 , which is
appropriate for absorption
Iron,although low,is better absorbed
6. immunologic factors
SIgA, lactoferrin,bifidus factor,lysozyme,
macrophages,
Advantages of breast feeding
1. can satisfy growth need of the first months,   is the
most ideal food and drink.
2. contain abundant antibody, immunizing cell and
substance, enhance anti-infection ability.
3. appropriate temperature and secrete speed, fresh, free of
germ, convenient, labor-saving, economics.
4. strengthen the affection between mother and child
5. stimulate the uterine contraction, promote the mother
recovery
Feeding highlight

• Feeding position
• Normal feeding( table 41-6,-7)
• Maintaining feeding
nutrition , sucking , relaxation
Mother-infant transmission disease
 
Weaning  

• Weaning should be initiated at 6-12months


of age
• Generally before 1and half year
• gradually reduce breast milk
• Selection of appropriate time
2.Combined feeding
• breast feeding +artificial feeding
3.Artificial feeding
Disadvantages of cow milk
• Higher casein tough
• Lower unsaturated fatty acid
• Fewer amount of lactose than human milk
• The ratio of calcium to phosphorus (1.2:1)is not
appropriate for absorption
• The burden of kidney is increaed by the greater
amount of minerals
• Lack of immunologic factors
Cow milk reprocessed in family
dilute, sweeten (5%~8%), sterilization
Energy provided by milk
• whole cow`s milk 66kcal/100ml
• 100ml 8%sugared-milk
66kca+8gx4kal/g ~100kcal
• Caculation 5mo wight 7kg

Total daily energy need:7x110=770


The amount of daily milk required: 770ml
The amount of daily water required :
7x150=1050ml
Supply water besides milk:
1050ml–770ml=280ml
Divided into 5~6 times per day
Other milk substitutes
• Evaporated milk
• Dried skim milk Goat `s milk
• Infant formulas
• Soy formula
4.Add complemental food   

• Principle
1. little-much
2. thin-thick
3. fine-gross
4. one kind-many kinds
IV. Arrangment of food for
children
• 1 suitable  
• 2 easy to digest
• 3 enjoy joining
• 4 good surroundings
Key pionts of the chapter
• energy requirement includes basal metabolism ,the thermic
effect of food ,energy required for growth, physical
activities, elimination
• total energy requirement :infant 110 kcal/kg.d,
with subsequent decrease of about 10kcal/kg for each
succeeding 3yr period
• The distribution of calories protein 10-15%
carbohydrate 50-60% fat 35-50%
• The resource of energy :
protein or carbohydrate provides 4 kcal/g
fat provides 9kcal/g
• Water requirement :Infant 150ml/kg.d ,
rule continue 3yr decrease 25ml
• Advantages of breast feeding
• Calculation for the amount of cow`s milk
required by infant

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