Académique Documents
Professionnel Documents
Culture Documents
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.
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)
• 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
• 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