复旦儿科学课件：儿童营养与喂养

Childhood

Nutrition

NutritionalrequirementsTolive,togrowandthrive,humansmusttakeinnutrientsfromtheirenvironment.Beforebirththerearesuppliedbythemother,butthereaftertheymustbeingested.Iftoolittleisprovided,theinfantwillnotgrowandmaybecomeill,andtoomuchmayleadtotoxicityorobesity.Classificationofnutrients

(2000ChineseDRIs)EnergyMacronutrients

protein,fat,carbohydratesMicronutrients:Minerals,Vitamins

Otherdiet’scomponents

Dietaryfiber,water,andothers.

FunctionFoodsourcesRequirementEnergyFivebroadusestowhichenergyintakeisput:Basalmetabolism:50-60%Requirementforgrowth:20-30%Specificdynamicaction:7-8%Requirementforphysicalactivity:15-20Kcal/kg/dEnergylostinexcreta:10%Protein9~15%Carbohydrate45~55%

Fat35~45%1gprotein=4Kcal1gcarbohydrate=4kcal1gfat=9kcal<1y,110kcal/kg/dReduce10cal/kg/dwhenraiseevery3year一、EnergyNotes:Ifcaloriesarebeingobtainedfromavarietyoffoods,anadequateintakeofcalorieswillusuallyensureanadequateintakeofessentialnutrients.Thereforecaloriesshouldbethefirstitemtobeevaluatedinassessingadietaryhistory.二、MacronutrientsFunctionFoodsourcesRequirementProteinProteinisaconstituentofallbodytissues.Thereisarequirementforgrowthandformaintenance.Ininfantandchildren,optimalgrowthdependsonanadequatedietaryproteinsupplyMilkproduction,egg,fish,meat,beanetc.AnimalproteinisbetterthanplantproteinBreastfeeding2g/kg/dcowmilkfeeding3.5g/kg/dPlantproteinFeeding4g/kg/dNineessentialaminoacids:histidine，isoleucine,leucine,lysine,methionine,phenylalanine,threonine,tryptophan,andvalineConditionalessentialaminoacids:

cystine,taurine,arginineFunctionFoodsourcesRequirementFatEnergystorageandinsulationagainstcold,acushionforinternalorgans.Fatsarerequiredfortheabsorptionoffat-solublevitaminsandformyelinationoftheCNSAnimalfat,meat,milkproduction,plantoil,plant<6y,3-6g/kg/d>6y,2.5g/kg/dFattyacidsaturatedfat:fatsofanimalorigin(excepthumanmilk)polyunsaturatedfat:fatsofvegetableoriginFunctionFoodsourcesRequirementCarbohydrateTosupplyenergycereal,fruit,legume,vegetableInfant10-12g/kg/dChildren12-15g/kg/dthreegroups:Mono-saccharides,disaccharides,polysaccharides三、MicronutrientsFunctionFoodsourcesRequirementmineralEssentialcomponentsofbodytissue.AnimalandplantfoodVitaminsVitaminsarenecessaryforpropertissuefunctionandforgrowth.Meat,liver,vegetables,fruitsMostvitaminscannotbesynthesizedinthebodyandmustbesuppliedinthedietCertainfoodsarefortifiedwithvitamins.AdditionofvitaminDtomilkismandatedbylaw.Withtheexceptionsofironandfluoride,awell-balanceddietwillprovideasatisfactoryintakeofminerals.Irondeficiencyisnowthecommonnutritionaldeficiencyintheworld.FunctionFoodsourcesRequirementWaterAlltissuescontainwateranditistheprincipalconstituentformosttissue.Mostchemicalreactionstakeplaceonlyinanaqueousmedium.Milk,soup,water<1y150ml/kg/d1-3y100ml/kg/d4-6y80ml/kg/dReduce10ml/kg/per3years四、OtherdietcomponentsLossofwater:LossinurineLossinfecalLossfromlungsandskin(insensiblewaterloss)FunctionFoodsourcesRequirementDietaryfiberSolublefiberdelayGItransitdelayglucoseabsorptionlowerbloodcholesterolInsolublefiber

accerateGItransitincreasefecalweightslowstarchhydrolysisdelayglucoseabsorption.Fruits(apple,citrus),oats,barley,legumesWheatbran,whole-grainbreads,cereals,vegetablesPointsonchildhoodnutrition

CaloriesshouldbethefirstitemtobeevaluatedinassessingadietaryhistoryAwell-balancedietInteractionofcarbohydrate,fatandproteinEnergy-proteinmalnutritionEvaluationofNutritionstatusClinicalexamination

Birthhistory;feedinghistory;Clinicsymptom&sign

Dietaryintakeinvestigation

InquiringmethodAnthropometricassessment

W/A,H/A,W/H,GrowthcurveLaboratoryassessment

Bloodsample,urinesampleInfantfeeding

Digestivesystem

anatomicphysiologicalcharacteristic

Mouth

Cheekfattymat

HypogenesisofneonatalsalivaglandAmylasedeficiency

OesophagusHypogenesisofoesophagealwallmuscleandbouncefiberStomach

Position

Cardiaconstrictor&pyloriconstrictorStomachcapacity

Digestivesystem

anatomicphysiologicalcharacteristic

Intestines

thelengthis6timesofbody’slength(adult’sintestineis4.5times)

Pancreas

<3monthinfant,theactivityofamylaseislower

Liver

quitelarger,thevolumeis4%body’svolume,(adult2%).soft

IntestinalbacteriumgroupBreastfeeding:themajorislactobacillusArtificialfeeding:themajorisEscherichiaColi.Normalstool

FetalstoolBreastfeedingCattle&sheepmilkColorDarkgreenGoldenStrawyellowCharacterSlimySlimy&softwithgrainHard，easyshackoffOdorNoodour

AcidodourProteindecomposedodourTimesNosurely>=4-5,orconstipation1-2InfantfeedingBreastfeedingArtificialfeedingMixedfeedingBreastfeedingBreastisbestHumanmilkisforhumansCowmilkisforcowsCompositionofbreastmilk

ColostrumsTransitionalbreastmilkMaturemilkTerminalstagemilkPeriod1week2wks-1mo2-9months>10monthscharacterDense,yellowFewfatHighglobinHighestfatDropofproteinandmineralProtein1.2g%Fat3.5g%Lactose7.5g%DeclineofamountandnutrientsAdvantageofbreastfeedingBetternutritionalqualities:

EasilydigestedProtein:wheyproteins(lactalbuminandlactoglobulins)accountfor2/3Fat:unsaturatedfattyacids,linoleicacid,richinlipaseLactose:higherconcentrationsLowrenalsoluteload:ashcontentofhumanmilk(0.2%)islessthanone-thirdthatofcowmilk(0.7%)

Favorablecalciumtophosphateratio:ensurecalciumabsorptionBetteriron,zincAdvantageofbreastfeeding

Anti-infectiveproperties

Secretory

IgA

Lysozyme

(溶菌酶）

Phagocyticcells（吞噬细胞）

Iron-bindingproteinLactoferrin

（乳铁蛋白）

Low-polysaccharidZincVitaminB12

Bifidusfactor（双歧因子）Advantageofbreastfeeding

Psychologicbenefit

Promotesmaternal-infantbondingGainasenseofsecurityConstitutethefoundationforthedevelopmentofallhumansocialrelationshipsandcommunications

othersEconomy,convenienceLackofcontaminationAdvantageofbreastfeeding

Benefitforthemother

Stimulation,bysucking,ofoxytocinsecretions,whichfostersuterinecontractionsandhastenspostpartumuterineinvolutionPossibledecreasedriskofpostpartumthromboembolismandbreastcancerEmotionalsatisfactionandsenseoffulfillmentArtificialFeedingMilkproductionincommonuse:

freshcow’smilk,sheep’smilk,infantformula,yoghourt,exhalationmilkSoyaformula,Soyamilk,riceflourFeedingschedule:avoidoverfeedingMixedFeeding

suppletheinadequateofbreastfeedingsubstituteofbreastfeedingCompositionofdifferentmilk(per100ml)

CompositionBreastmilkCow’smilkSheep’smilkEnergy(kcal)666669Protein(g)1.2（lactalbuminaccountfor2/3）3.5（caseinaccountfor4/5）3.3Fat(g)3.5（themajorisliquidfat）3.5（themajorisvolatilityfattycid）4.1Lactose(g)7.54.84.7Mineral(g)0.20.70.77Calcium(g)0.0330.1250.061Phosphorous(g)0.0150.0990.055Iron(g)0.000210.000150.001Sodium(g)0.0150.0580.018Potassium(g)0.0550.1380.046VitaminD(IU)0.4－10.0IU0.3－0.4IULipaseMoreLessWater(g)87.587.586.7α-lactalbuminOtherwhey

proteinsCaseinα-lactalbuminß-lactoglobulinOtherwhey

proteinsCaseinBovineMilkHumanMilkMilkProteinCompositionCaseinOtherwhey

proteins

NutrientsandenergydailyrequirementforinfantsEnergy(kcal)Water(ml/kg)Protein(g/kg)fat(g/kg)Carbohydrate(g/kg)Calcium(mg)Iron(mg)Zinc(mg)VitaminAIUB1mgB2mgCmgDIUEmg1101501.7-4.04-610-1250015510000.50.5505005以后每年减25％15%35％50％Energy:100mlfreshmilkinclude66kcal5%sugarymilk86kcal8%sugarymilk98kcalExample:6monthsinfant,WT7kgEnergydailyrequirement:110

7＝770kcal，beequalto770mlmlLiquiddailyquirement:150ml

7=1050ml,stillneedtosupplywater280ml.

Theintroductio