Nutrition In Children

1. INTRODUCTION
Dr Nicola Flynn
•Research Associate Under Dr Dilip Mahalanabis Society for applied
studies, Salt Lake Kolkata.
•Consultant Pediatrician & Neonatologist, Ruby General Hospital,
Kolkata.

2. Nutrition In
C
h
i
l
d
r
e
n

3. •Children, our future, form
one third of our population.
•Growth is the best global
indicator of children’s well-
being.
•Adequate food intake is
essential for proper growth.
•Low food intake can affect
their physical and mental
growth.
Impaired growth and development in children can affect the
rest of their lives
Child’s Health and Future

4. Malnutrition and Child
•Asia has largest number of
malnourished children
•India accounts for 40% of
malnourished children in
the world
•UNICEF estimates that
malnutrition affects
physical and mental
function of 2 billion
children.
According to WHO and UNICEF estimates, 60% of child deaths are
malnutrition associated.
1 in 3 of the world's malnourished children lives in India
1

5. Child and Physical Development
•Rapid growth happens
between infancy and
adolescence
•Nutrition is vital during the
growth phase
•Inadequate nutrition affects
growth and muscle
development
Boys
Girls

6. Child and Mental Development
0% of
Brain
deve
lopm
ent
20
40
60
80
100
Time p eriod2 5 wks 3 0 wks 3 5 wks 4 0 wks 1 yr5 yrs
0% of
Brain
deve
lopm
ent
20
40
60
80
100
Time p eriod2 5 wks 3 0 wks 3 5 wks 4 0 wks 1 yr5 yrs
Critical Periods for Brain Growth
Brain Growth Across the Years

7. Factors that Affect Child Growth

8. Nutrition and Child Development
Outcomes of inadequate diet
•Poor growth
•Poor cognition
•Poor muscle development
•Reduced work capacity
•Poor social development
•High rates of illness
•Difficulty in school
Nutritional status of children during the critical period
is of paramount importance for later physical, mental &
social development.

9. Reference: Nutrient requirement and RDA for Indians , ICMR , 1990
Nutritional requirement of preschoolers
Nutrient Requirements of Young Children is
Manifolds of Adult Requirements

10. Gaps in Mean Intake of Nutrients amongst
Children in India
Micronutrient deficiencies represent a hidden form of hunger with severe
consequences on physical growth, immune functions, cognition and productivity
Graph depicting the micronutrient intake of Indian children (Boys and girls) in the age group of 7–15
years as compared to 100% RDA as per NNMB 1996 Data. (RDA marked as dotted line)
30

11. Nutrients
Macronutrients Micronutrients
carbohydrates Proteins Fats VitaminsMinerals
Fat soluble
vitamins
Water
Soluble
Vitamins
Saturated
Unsaturated
Monosaccharide
Disaccharide
Polysaccharide
Complete
proteins
Incomplete
proteins
Poly Unsaturated
Mono Unsaturated

12. Deficiency of Nutrients and Physical
Development
Micronutrient
Deficiency
Effects
Vitamin D and
calcium
Deficiency affects bone
development
Potassium, zinc,
magnesium and copper
Deficiency disturbs the growth
hormones and affect growth
Manganese Deficiency leads to skeletal
abnormalities including retarded
growth
Vitamin E Deficiency affects muscle
development

13. Deficiency of Nutrients and Mental
Development
Micronutrient Deficiency manifestations
Vitamin B
1
•Reduction of the brain content of neurotransmitters.
•Reduced levels of brain GABA, glutamate and aspartate
Vitamin B
2
•Impaired performance on psychomotor tests, neuromotor
incoordination and personality changes
Vitamin B
3
•Loss of memory, nervousness, easy distractibility and
schizophrenia
Vitamin B
6
•Depression, irritability, loss of memory, inability to
concentrate, peripheral neuritis
Vitamin B
12 •Loss of memory, disorientation and emotional instability
Folic acid
•Memory loss, forgetfulness, depression, irritability,
introversion, lack of confidence
Vitamin C
•Reduced score for IQ, memory, abstract thinking and non-
verbal intelligence, altered behavior
Vitamin E •Poor memory and attention span

14. Deficiency of Nutrients and Mental
Development
Micronutrient Deficiency manifestations
Iodine
•Poor somatic and central nervous system growth,
sluggishness, inactivity, lethargy, poor concentration,
impaired cognition and incoordination.
•Sequel leading to minimal brain function to a syndrome of
severe intellectual disability.
•Global loss of 10–15 intellectual quotient
Iron
•Listlessness, apathy, lack of vigor and enthusiasm, lower
scores on motor development and cognitive tests and poor
school grades-
•Less myelinization and altered neurotransmitter function
Zinc
•Lethargy, decreased visual memory, impaired cognitive
development and neuropsychological problems
Selenium •Depression, low mood, low energy level, anxiety and stress
Choline •Poor memory and mental functioning
DHA
•Short memory span, poor ability for discrimination,
aggression, hostility, learning disability, dyslexia? attention
deficit disorder

15. Deficiency of Nutrients and Immunity
Micronutrient deficiency Effects
Vitamin A Impairs immuno competence, therefore it can
increase the risk of infection
Vitamin E Impair several aspects of the immune response,
including B- and T-cell mediated immunity
Vitamin C Impaired inflammatory responses & function of
phagocytes
Zinc Impaired lymphocyte responsiveness & T cell
development
Selenium Impaired antibody production

16. •Frequent illness adversely affects growth &
development of children
1
•Growing children need the BEST nourishment with
all essential nutrients in recommended quantity
2
for
Optimal immune function
Faster recovery
Healthy physical growth
Mental development
• Journal of Nutrition. 1999;129:531-533.
•Healthy Nutrition: An Essential Element of a Health-Promoting School. WHO, FAO and Education
International, 1998. WHO Information Series on School Health – Document 4. Geneva: WHO

17. Essential Fatty Acids
The Essential Fats are a group of fatty acids
that are essential to human health.
•Omega-3 (w3) – Linolenic acid
•Omega-6 (w6) – Linoleic acid

18. Structure of EFAs
LINOLEIC ACIDS (Omega 6)
Eighteen-carbon essential fatty acids that
contain two double bonds.
•18:2 (9,12)
–LINOLENIC ACIDS (Omega 3)
Eighteen-carbon essential fatty acids that
contain three double bonds
18:3 (9,12,15)

19. Function of EFAs
•Formation of healthy cell membranes
•Proper development and functioning of the brain
and nervous system
•Production of hormone-like substances called
Eicosanoids
–Thromboxanes
–Leukotrienes
–Prostaglandins
Responsible for regulating blood pressure, blood viscosity,
vasoconstriction, immune and inflammatory responses.

20. Omega-3s
•Sources:
Walnuts
Wheat germ oil
Flaxeed oil/canola oil
Fish liver oils/Fish eggs
Human Milk
Organ meats
Seafood/Fatty fish
- albacore tuna
- mackerel
- salmon
-sardines

21. Benefits of Omega-3s
•Lower PG2s
•Anti-inflammatory
•Lower triglyceride and
cholesterol levels
•Cancer prevention
•Renal maintenance
•Increase insulin sensitivity
•Enhance thermogenesis and
lipid metabolism
•Benefits vision and brain
function
•Decrease Skin inflammation
•Inhibit platelet adhesion

22. Reports of w-3 Deficiency
•Holman and colleagues reported a case of peripheral
neuropathy and blurred vision in a child receiving total
parenteral nutrition devoid of omega-3 fatty acids for 5
months.1

-Holman et al. AM J Clin Nutr 35:617, 1982
•Bjerve and his coworkers reported linolenic acid deficiency in
nine patients fed by gastric tube for 2.5 to 12 years, who had
received only 0.025% to 0.09% of their total kilocalories as
omega-3 fatty acids.
-Bjerve et al. Am J Clin Nutr 45:66, 1987.

23. Platelet aggregation, cardiovascular
diseases, and inflammation
Sources:
Corn oil
Peanut oil
Cottonseed oil
Soybean oil
Many plant oils
Omega-6s

24. Benefits of Omega-6s
Specifically, omega-6 fatty acids
with a high GLA content may
help to:
•Reduce inflammation of
rheumatoid arthritis
•Relieve the discomforts of
PMS, endometriosis, and
fibrocystic breasts.
•Reduce the symptoms of
eczema and psoriasis.
•Clear up acne and rosacea.
•Prevent and improve diabetic
neuropathy.
•Excessive amounts of omega-6
(PUFA) and a very high
omega-6/omega-3 ratio has
been shown to promote the
pathogenesis of many
diseases:
-cardiovascular disease
-cancer
-Inflammatory and
autoimmune diseases

25. Essential Fatty Acid Deficiency Side
Effects
•hemorrhagic dermatitis
•skin atrophy
•scaly dermatitis
•dry skin
•weakness
•impaired vision
•tingling sensations
•mood swings
•edema
•high blood pressure
•high triglycerides
•hemorrhagic folliculitis
•hemotologic disturbances
(ex: sticky platelets)
•immune and mental
deficiencies
•impaired growth

26. Dermatitis, Atopic in an Infant and on a Young Girl's Face

27. Differing characteristics w-3 and w-6
Essential Fatty Acid Deficiencies
Omega-3 (a-Linolenic Acid) Omega-6 (Linoleic Acid)
Clinical
Features
Normal skin, growth, reproduction
Reduced learning
Abnormal electroretinogram
Impaired vision
Polydipsia
Growth retardation
Skin lesions
Reproductive failure
Fatty liver
Polydipsia
Biochemical
markers
Decreased 18:3 w-3 and 22:6 w -3
Increased 22:4 w-6 and 22:5 w 7
Increased 20:3 w-9(only if w -6 also low)
Decreased 18:2 w-6 and 20:4 w-6
Increased 20:3 w-9 (only if w -3 also
low)
Guthrie H, Picciano, Mary. Human Nutrition. Lipids p128 1995

28. Who are at risk for deficiency?
•Long-term TPN patients
without adequate lipid
•Cystic Fibrosis
•Low Birth Weight Infants
•Premature infants
•Severely malnourished
patients
•Patients on Long-term
MCT as fat source
•Patients with fat
malabsorption
•Acrodermatitis
Enteropathica
•Hepatorenal Syndrome
•Sjogren-Larsson
Syndrome
•Multisystem neuronal
degradation
•Crohn’s disease
•Cirrhosis and alcoholism
•Reye’s Syndrome
•Short bowel syndrome

29. Recommendations: Infants & Children
•The American Academy
of Pediatrics recommends
that infant milk formula
should provide at least
2.7% of total kilocalories
in the form of linoleic
acid.
•Of note, human milk
provides 3.5% to as high
as 12% of total
kilocalories in the form of
linoleic acid depending
on the fat composition of
the maternal diet.
AI for Infants and Children
0-6 mos 0.5 g/day of n-3 PUFA
7-12 mos 0.5 g/day of n-3 PUFA
1-3 yrs 0.7 g/day of a-linolenic acid
4-8 yrs 0.9 g/day of a -linolenic acid
Boys
9-13 yrs 1.2 g/day of a -linolenic acid
14-18 yrs 1.6 g/day o a-linolenic acid
Girls
9-13 yrs 1.0 g/day of a -linolenic acid
14-18 yrs 1.1 g/day of a -linolenic acid
Food and Nutrition Board, Institute of Medicine (FNBIOM,2001)

30. DHA
DHA is one of the primary structural component of brain tissue and retina
Docosahexaenoic acid (DHA) is an omega-3 essential fatty
acid
DHA and Brain DHA and Retina

31. DHA Aids Brain Cell Maturation
A - Less astrocytes maturation when cultured in serum deficient conditions.
B, C, D - Improved maturation of astrocytes as DHA is supplemented in
increasing concentrations.
Improved maturation of astrocytes with higher
concentrations / levels of DHA
Animal studies have indicated a causal connection between DHA
availability & cognitive or behavioral performance

32. DHA and Neurotransmission
DHA is an important constituent of the brain cell
membrane, which have a role in neurotransmission
G-proteins are structures that are present on the cell membrane &
assist in movement of nutrients

33. Human Beings are Poor DHA Synthesizers
Less than 0.2% of ALA is converted to DHA in the hepatocyte
Hence, it becomes important to directly consume DHA
during crucial periods of brain growth

34. DHA in ActiGrow DHA from fish
oil
Significance
Free of high levels of
mercury, oceanic
pollutant and toxins
High mercury
levels
Undesirable levels of mercury and
oceanic pollutant have the potential
to damage the tissues
More stable Less stable The oxidative stability of long chain
polysaturated fatty acids (PUFA)
and DHA containing fish and algae
oils varies widely according to their
fatty acid composition. DHA from
algal sources is found to be ten
times more stable than fatty acids
derived from fish oils.
Desirable EPA
content
Higher EPA
content
Not desirable during growing
phase
from a vegetarian source

35. Thank You