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› Chairman & Managing Director - Nephron Clinic
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› Chairman Medical Advisory Board (MHDPL), Manipal Hospital (Dwarka)
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Nutrition

Issue of immense national importance.

  1. Children have high maintenance needs, high metabolic and nutrient turn over rates.
  2. Children have marked organ development and functional changes.
  3. Requirements vary with respect to age, weight, sex, disease status etc.

Nutrition : Lets begin……..

  1. Children achieve 80% of their growth potential in the first 3 to 5 yrs. of life.
  2. Nutrition, illness etc. play and important in physical  growth, mental development, psychosocial Dev., bone  growth, dentition, sexual maturation etc.

Nutrition : Calories

  1. Calories : - measured as energy requirement for physical activity and growth.

(K Calories).

  1. 1 gm of protein gives 4 kilo Calories.
  2. 1 gm fat gives 9 kilo Calories
  3. Caloric requirement –

            1 yr = 115 Kcal / Kg
            1 – 3 yrs. = 1350 Avg.
            4 – 6 yrs. = 1850 Avg.
            7 – 9 yrs. = 1200 Avg.
            10 – 19 yrs. = 2600 – 3000 Avg.

Nutrition : Protein

  1. Polypeptides containing aminoacids
  2. Essential Amino Acids – Leucine, Isoleucine, Lysine  Methionine, Valine  etc.
  3. Non essential amino acids
  4. Crucial for growth, formation of digestive juices, hormones, plasma proteins, enzymes, vitamins, hemoglobin.
  5. Class A or biological complete protein – animal proteins
  6. Requirement –

1 yr old = 1.5 gms / kg / day
4 – 6 yrs = 20 gms / day
7 – 9 yrs = 25 gms / day
10 – 18 yrs = 30 to 40 gms / day

Nutrition : Obesity

  1. Obesity – 17 – 23% increased risk of hypertension, leptin receptors (Chr. 7), insulin resistance, hyper insulinemia, increased leptin levels, diet, Na intake,

Na sensitivity (50% ass.), life style, parental education, family history, computers and sedentary lifestyle.

Nutrition : Fats (Lipids)

  1. 35% of daily caloric requirements of lipids.
  2. Essential fatty acids (poly unsaturated FA)
  3. Source - corn oil, sunflower oil.

Nutrition : Calcium

  1. Essential for bone development, dentition, muscle activity, over all growth.
  2. Requirement = 1 yr - 500 mg / day

                                 older child - 700 mg / day
                                 adult - 500 mg/ day

  1. Source – milk, millets, nonveg food.
  2. Regulation with Vit. D

Nutrition : Phosphorus

  1. Normally present in veg and nonveg diet important for dentition bone growth and muscles.
  2. Normal requirement = 400 – 500 mg / day in childhood.
  3. Works in conjunction in calcium levels.
  4. Normal ratio of Ca x P = < 50.
  5. If ratio more – e.g. Chronic Kidney Disease etc.

Nutrition : Iodine

  1. Normal secretions of thyroid gland.
  2. Deficiency Causes  Hypothyroidism.
  3. Excess causes - Hyperthyroidism.
  4. Source – sea food, non veg and veg diet, salt 
  5. Requirement – 0.1 – 0.15 mgs/ day         

Nutrition : Fluorine

  1. Prevents Dental caries.
  2. Source  - sea food and tea, drinking water.
  3. Excess causes – flouorosis.
  4. Requirement = 0.2 mgs/ day.
  5. Water contains 2 parts per million normally.       

     
Nutrition : Zinc

  1. Essential part of several enzymes.
  2. Deficiency causes growth failure, hypogonadism, anemia, liver dysfunction.
  3. Source – meat, fish, wheat.
  4. Requirement – 22 mgs./ day.

Nutrition : Magnesium

  1. Essential part of several enzymes.
  2. Deficiency causes growth failure, Malnutrition, CRF, Diarrhea, Irritability, anemia, liver dysfunction, muscle cramps.
  3. Source – meat, plant food (milk is a poor source).
  4. Requirement – 200 - 300 mgs./ day.

Nutrition : Copper

  1. Essential part of several enzymes, helps in iron absorption.
  2. Deficiency causes growth failure, Malnutrition, Diarrhea, Irritability, anemia, liver dysfunction.
  3. Excess Causes – Chronic Liver Disease.
  4. Source – meat, liver, Sea food, nuts, raisins (milk is a poor source).
  5. Requirement – 80 – 40 mgs./ day.

Nutrition :Miscellaneous

  1. Chromium
  2. Selenium
  3. Cobalt
  4. Molybdenum
  5. Folate

Nutrition :A paradox 

  1. Inspite of protein Calorie Malnutrition decreasing in the upper strata of society, obesity has become more prominent in almost 40% of school going children.
  2. Inspite of children being of adequate weight or, over weight, they still show nutritional   deficiencies.
  3. Fast food, colas, unhealthy fried items etc.
  4. Grow charts and normograms of height, weight, BP, BMI charting.

Nutrition :Vit. B1(Thiamine) 

  1. Deficiency – beri beri, cardiac, swelling, vomiting, convulsions etc.
  2. Requirement = 1 mg / day
  3. Source – wheat, lentils, dal, nuts, meat, eggs.

Nutrition :Vit. B2(Riboflavine) 

  1. Deficiency – Glossitis, Dermetitis, Eyes – Keratitis
  2. Requirement - 1.5 mgs / day
  3. Source – leafy vegetables, methi , sag, soyabenas, wheat, eggs.

Nutrition :Niacin 

  1. Deficiency – Diarrhea, Muscle Weakness, Memory Loss, Dermatitis etc.
  2. Requirement - 5  - 15 mgs / day
  3. Source – Nuts, rice, liver, Leafy vegetables, wheat.

Nutrition : B6 (Pyridoxine) 

  1. Deficiency – Failure to thrive irritability anemia vomiting.
  2. Requirement – 1 – 2  mgs / day
  3. Source – mixed diet

Nutrition : Folic Acid

  1. Deficiency – Megaloblastic Anemia .
  2. Requirement – 100 micro gms / day
  3. Source – leafy veg, dates, liver, milk.  (95% of folic acid is lost by over cooking)

Nutrition : Vit. B12 (Cyancobalamin)

  1. Deficiency – Anemia, Spinal Cord problems.
  2. Requirement – 1.5 micro gms / day
  3. Source – Liver, leafy veg, milk. 

Nutrition : Vit. C (Ascorbic Acid)

  1. Deficiency – lethargy, fretful, tender bones, muscle weakness, gum and skin bleeding, rash.
  2. Requirement – 20 mgs / day
  3. Source – citrus fruits, veg, papaya, tomato etc.

Nutrition : Vit. A

  1. Deficiency – Night blindness, skin changes, respiratory infections, failure to thrive.
  2. Requirement – 400 micro mgs / day
  3. Source – butter, ghee, veg, mango, carrot, spinach etc.

Nutrition : Vit. D

  1. Deficiency – Bone changes with rickets, failure to thrive, weakness, fractures.
  2. Requirement – 10 micro mgs / day
  3. Source – oil, ghee, sea food, egg etc.
  4. Sun light ??

Nutrition : Iron

  1. Deficiency – failure to thrive, weakness, irritability, memory loss, etc.
  2. Requirement – .5  mgs / day
  3. Source – Oil, ghee, Sea food, eggs, meat etc.
  4. Iron Deficiency, nutritional, blood disorders, G6 PD, Thallamesia etc.
  5. Neonatal screening crucial**
  6. School health programmes crucial**

Nutrition: Investigations

  1. Haemogram, Electrolytes , RFT, LFT, ABG.
  2. Uric Acid, Ca, P, ionic gap.
  3. Urine R/M, C/S, E/U/C (Fe Na.)
  4. PRA, Aldosterone, LH, FSH, GH, insulin, Testosterone, T3, T4, TSH.
  5. C3, C4, ANA, DNA Ds, ANCA, Anti GBM Ab.
  6. Genetic investigations.

Nutrition : Investigations

  1. ECG, ECHO, Fundus
  2. X-ray Chest, USG Abdomen & KUB, Doppler.
  3. Vit. And mineral levels in blood
  4. Bone marrow

Nutrition : Examination

  1. BP & Pulses in all four limbs *.
  2. Cutaneous – skin lesions, rash.
  3. CNS – bell’s palsy, encephalopathy, retinopathy
  4. CVS – CCF, PP & BP diff in UL & LL.
  5. RS – pulmonary infections
  6. P/A – bruits, masses, palpable kidney
  7. Endo – thyromegaly,  virilization, cushingoid
  8. Genetic – turner’s, william’s, neuromas, etc.
  9. Fundus

HT : Treatment

  1. Non Pharmological :

            Weight control, diet, exercise, no smoking or drug abused.

  1. Pharmological :

            Supplementation of vitamins, minerals, iron etc.
            Choice of treatment :
Rational approach, doses with regards weight and age, no over use, chemists can be devils, no self treatment, avoid myths, food pyramid, wrong promotion in market of protein supplements.

Nutrition Rx : Contraindications

  1. Renal Stones, Eyes, Skin, Brain, Teeth etc.