营养障碍疾病医疗管理分析

NutritionandDystrophicDisease营养及营养障碍疾病,PresentedbyWangxia,DepartmentofPediatric,XiangyaHospital,CentralSouthUniversity,ObjectivesandDemands,Theprinciplesofinfantfeedingandintroducingsupplementalfoodsintoababysdiet,Thediagnosis,treatmentandprophylaxisofProtein-energymalnutrition,Thediagnosisandtreatmentofobesityinchildren,Tomaster,NutritionalRequirementsandInfantFeeding,营养基础及婴儿喂养,Introduction,LownutritionalstoresHighnutritionaldemandsforgrowthRapidneuronaldevelopment,Infantsandchildrenaremorevulnerabletopoornutritionthanareadults,dietaryreferenceintakes（DRIs）,平均需要量EAR(estimatedaveragerequirement)推荐摄入量RNI(recommendednutrientintake)适宜摄入量AI(adequateintake)可耐受最高摄入量UL(tolerableupperintakelevel)一个人群的RNI=EAR+2SD,requirementsofenergy,Including:basalmetabolism50%forthermiceffectoffood(TEF)78%forphysicalactivityforexcreta10%forgrowth,requirementsofnutriment,EnergyMacronutrient:protein、fat、carbohydrateMicronutrient:mineral、vitaminOtherelement:foodfiber、water,Changesinenergyandwaterrequirementswithage,Age(year)Energy（kcal/kg）Water（ml/kg）Infant1101501310012547901007980751012707513156050Adult40504050,Sourcesofprotein,Animalprotein,Plantprotein,Thequalityofproteindependsonitsaminoacidcomposition,Essentialaminoacid,Adult:8Infant:histidinePreterminfant:cystine,tyrosine,arginine,taurine,Sourcesoffat,essentialfattyacid,Infantfeeding,BreastfeedingMixedfeedingArtificialfeedingTransitionsininfantfeeding,Breastfeedingandcomplementaryfeedingtermsanddefinitions,EXCLUSIVEBREASTFEEDING:theinfanttakesonlybreastmilkandnoadditionalfood,water,orotherfluidswiththeexceptionofmedicinesandvitaminormineraldrops.MIXEDFEEDING:theinfantisgivensomebreastfeedsandsomeartificialfeeds,eithermilkorcereal,orotherfoodorwater.ARTIFICIALFEEDING:theinfantisgivenbreast-milksubstitutesandnotbreastfeedingatall.,Breastfeeding,Cowmilkforcowbabieshumanmilkforhumanbabies,Babiesareborntobebreastfed,Itstooimportantnotto!,Advantagesofbreastfeeding,Theidealandnaturalfoodforinfants:Nutrition，Immunity，BraindevelopmentandgrowthReducediseaseriskEconomicandconvenienceEstablishanintimate,lovingrelationshipMothershealth,WhyisBreastfeedingImportant?,NutritionallycontainsthecorrectbalanceofallnutrientswhentheyareneededProteinquality:Moreeasilydigestedcurd(1:4casein:wheyratio)RichinbetalactoseLipidquality:Richinoleinacid.ImproveddigestibilityandfatabsorptionCalcium:phosphorusratioof2:1Lowrenalsoluteload(infantformuladoesnotchangewithbabyschangingneeds),Immunity-breastmilkcontainsprotectionagainstinfectionsandinflammation,nomatterwhatageorstageofbreastfeeding.(secretoryIgA,bifidusfactor,lysozyme,lactoferrin,oligose,interferon,livingcells),WhyisBreastfeedingImportant?,eczema,Breastfeedingdecreasestheriskofallergicdisordersaprospectivebirthcohortstudy,AdaptedfromKullI.etal.Breastfeedingandallergicdiseasesininfants-aprospectivebirthcohortstudy.ArchivesofDiseaseinChildhood2002:87:478-481.,DIARRHEALILLNESSAMONGBREASTFEDandFORMULAFEDINFANTS,Adaptedfrom:Deweyetal(1995):699-700,%Daysill,%Daysill,OTITISMEDIAAMONGBREASTFEDandFORMULAFEDINFANTS,DIARRHEALILLNESSAMONGBREASTFEDandFORMULAFEDINFANTS,Adaptedfrom:Deweyetal(1995):699-700,%Daysill,%Daysill,OTITISMEDIAAMONGBREASTFEDandFORMULAFEDINFANTS,DurationofbreastfeedingassociatedwithhigherIQscoresinyoungadults,Denmark,Adaptedfrom:MortensenEL,MichaelsenKF,SandersSA,ReinischJM.Theassociationbetweendurationofbreastfeedingandadultintelligence.JAMA,2002,287:2365-2371.,Economicbenefits,breastfeedingcostslessthanartificialfeedingnospecialdietformother(digestion+);healthcare$reducedwhenbabies/momshealthier;nocostofformula($600-$3000/yr)breastfeedingresultsinlowermedicalcarecostsDiabetes,childhoodcancers,earinfections,Crohns,morbidityetc,Alwaysready!Nowaste!,WhyisBreastfeedingImportant?,Benefitsofbreastfeedingforthemother,ProtectsmothershealthhelpsreducesriskofuterinebleedingandhelpstheuterustoreturntoitsprevioussizereducesriskofbreastandovariancancerHelpsdelayanewpregnancyHelpsamotherreturntopre-pregnancyweight,Summaryofdifferencesbetweenmilks,Adaptedfrom:Breastfeedingcounselling:Atrainingcourse.Geneva,WorldHealthOrganization,1993(WHO/CDR/93.6).,母乳分期Stagingofbreastmilk,periodvolumecharacteristic初乳within45d15-45ml/dyellowmoreprotein,VitA,taurine,mineralcolostrum过渡乳5-14d500ml/dwhite,morefatproteinandmineralproteintransition成熟乳after14d700-1000ml/dAllingredientsquantityandingredientsmature,compositionofbreastmilkchangesduringonefeedingsession,Thefirstpart：fat，proteinThesecondpart：fat，proteinThethirdpart：fat,Estabilshingandmaintainingthemilksupply,Preparationbeforedelivery:gainweight(1214kg)AppropriatecarefornipplesThefirstbreast-feedingshouldtalkplaceassoonaspossibleafterbirth.InfantsshouldbefedondemandPromotinglactationAppropriatetechniqueofbreast-feeding.Nofactorismoreimportantforsuccessfulbreast-feedingthanahappy,relaxedstateofmind.,Themostsatisfactorystimulustothesecretionofhumanmilkisregularandcompleteemptyingofthebreasts.,Contraindicationstobreast-feeding哺乳禁忌,绝对禁忌HIV、慢性肾炎、糖尿病、恶性肿瘤、心功能不全、精神病、癫痫相对禁忌乙肝病毒携带者、无临床症状的结核病,部分母乳喂养mixedfeeding,补授法SupplementalFeeding母乳哺喂次数一般不变，先哺母乳，再补充乳品或代乳品代授法Breast-bottle-feeding乳品或代乳品代替一至数次母乳喂养,人工喂养,Bottle-fed,概念definition,Theuseofasubstituteforbreastmilkforfeedinginfants4个月以内的婴儿，由于