Lewis Final

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Lewis Final
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  1. Overweight
    BMI for age percentile ≥ 85 and < 95
  2. Obese
    BMI for age percentile ≥ 95
  3. Resources for Childhood Obesity
    • Georgia Department of Public Health-Nutrition and Physical Activity Initiative
    • Georgia- Policy Leadership for Active Youth
    • Strong4life
  4. Metabolic Syndrome: Obesity Risk Factors
    • Abdominal obesity (Waist circumference)
    • TG
    • HDL-C
    • Blood pressure
    • Fasting glucose
  5. Metabolic Syndrome: Abdominal Obesity
    • Men: >102 cm (> 40 in)
    • Women: >88 cm (> 35 in)
  6. Metabolic Syndrome: TG
    >150 mg/dL
  7. Metabolic Syndrome: HDL-C
    • Men: <40 mg/dL
    • Women: <50 mg/dL
  8. Metabolic Syndrome: Blood Pressure
    >130 / >85 mm Hg
  9. Metabolic Syndrome: Fasting Glucose
    >110 (>100**) mg/dL
  10. Characteristics of Overweight Children
    • Are taller
    • Have advanced bone ages
    • Experience earlier sexual maturity
    • Look older
    • Are at higher risk for obesity-related chronic diseases
  11. Predictors of Childhood Obesity
    • Age at onset of BMI rebound
    • -Normal increase in BMI after decline
    • -Early BMI rebound, higher BMIs in children later
    • Home environment
    • -Maternal and/or Parental obesity predictor of childhood
    • obesity
  12. Prevention of Overweight
    • Socio-Ecological Model
    • Reduce sedentary behaviors
    • Increase physical activity
    • Improvements in nutrition
    • Involve the family
    • Encourage changes in the environment that will help children eat better and be more active
  13. Treatment of Overweight and Obesity
    • Stage 1: Prevention Plus
    • Stage 2: Structured Weigh Management (SWM)
    • Stage 3: Comprehensive Multidisciplinary Intervention (CMI)
    • Stage 4: Tertiary Care Intervention (reserved for severely obese adolescents)
  14. TV & Eating Habits
    • TV viewing (> 2 hrs) is related to obesity
    • Influences family food purchases
    • Food for activities other than satiety
    • Few obese children on TV – no consequences shown for poor choices
    • Increased snacking
    • Source of inactivity
  15. Treatment of Overweight and Obesity
    • Consists of a multi-component, family-based program consisting of:
    • -Parent training
    • -Dietary counseling/education
    • -Physical activity
    • -Behavioral counseling
  16. Middle Childhood
    Between the ages of 5 and 10
  17. Preadolescence
    • Ages 9 to 11 years for girls
    • Ages 10 to 12 years for boys
  18. Children's Eating Habits
    • Parents and older siblings influence the most
    • Parents are responsible for the food environment, children are responsible for how much they eat
    • Parents are important role models
    • Eat together as a family
    • Peer influences become greater and greater; also teachers and coaches; media
    • Snacks are important
  19. Factors Influencing Food Choices
    • Food acceptance
    • Parents
    • Family
    • Television
  20. Developing Food Patterns in Children
    • Food should be attractive
    • Environment should be pleasant and age appropriate
    • Serving sizes should be appropriate
    • Repeated exposure often helpful
    • Parents should be developing the healthy eating patterns in children
    • -Don’t force feed
    • -Don’t overly restrict ‘junk food’
    • -Influences should be positive
  21. Improve Diet Quality of Children
    • Increase vegetable and fruit consumption (4.5 cups/2,000 kcal)
    • Use MyPlate for food/diet planning tool
    • Calorie and portion control: should not put children on a very-low-fat diet; include complex carbohydrates
    • Consume skim or 1% fat dairy products (> 2 years of age) 
  22. Sources of Energy, Dietary Fats, and Added Sugars
    • 40% of total energy consumed was in the form of empty calories (433 from solid fat and 365 from added sugars)
    • One-half of empty calories came from soda, fruit drinks, dairy desserts, grain desserts, pizza and whole milk
  23. Dietary Recommendations for Children
    • Carbohydrates- 45-65%
    • Fats- 25-35%
    • Fruit and vegetable intake - consume 4.5 cups (9 servings) of fruits and vegetables per 2000 kcal daily
    • Drink 3 cups of non-fat or low fat milk or equivalentdairy products (children > 9 years of age)
  24. AI of Total Fiber
    • Children, 4-8- 25 g/day
    • Boys, 9-13- 31 g/day
    • Girls, 9-13- 26 g/day
  25. Key Nutrients for Children
    • 1-3 years: RDA- Iron- 7 Zinc- 3
    • 4-8 years: RDA- Iron- 10 Zinc- 5 
    • 9-13 years: RDA- Iron-8 Zinc-8
  26. Calcium Recommendations for Children
    • After 2 years of age, choose low-fat or nonfat dairy foods and foods fortified with calcium
    • If requirements cannot be met with foods alone, supplement with calcium tablets or chews
    • 1-3 years: 700 mg/day
    • 4-8 years: 1,000 mg/day
    • 9-18 years: 1,300 mg/day
  27. Vitamin D Recommendations for Children
    • Two sources: sunlight (primary source) and diet
    • 0-18 years of age: 400 IU/day (AAP)
    • 0-18 years of age: 600 IU/day (FNB, IOM)
    • Good dietary sources are fortified milk and orange juice and fatty fish
    • Fortified sources vary; supplements are being recommended more often for children who do not get enough sunlight exposure
  28. National School Lunch Program
    • Federally assisted meal program
    • Provides free or low cost meals
    • Started in 1946 and now includes school breakfast and after school snacks
  29. School Health Index
    • Self assessment and planning tool for school
    • Developed by CDC
  30. The Child Nutrition & WIC Reauthorization Act of 2004
    • Requires all school districts participating in the National School Lunch or Breakfast Programs to have a wellness policy in place by 2006-2007
    • Improves access to child nutrition programs for military families
    • Ensuring Integrity, Efficiency, and Quality in the School Lunch Program
    • Strengthening WIC Program Integrity, Improving Nutrition, and Enhancing Infant Formula Benefits
  31. Building Blocks for Healthy Children
    • Released in October 2009
    • Increase the amount of fruits, vegetables and whole grains
    • Set a maximum level of calories per meal
    • Increase the focus on reducing saturated fat and sodium
    • Get meals and food intake in line with the 2005 Dietary Guidelines
  32. CDC Recommendations for School Lunch Programs
    • School health policy
    • Nutrition education curriculum
    • Instruction for students
    • Integrate school food service and nutrition education
    • Train staff
    • Family and community involvement
    • Program evaluation
  33. Old
    • There is no one age that defines “old”
    • 50—Eligibility for AARP
    • 60—Many businesses offer “senior discounts” & age used by the Elderly Nutrition Program
    • 65—Eligibility for full Social Security
    • U.S. Census Bureau uses:
    • -65 to 74—“young old”
    • -75 to 84—“aged”
    • -85 & older—“oldest old”
  34. Gerontology
    Refers to the study of aging, including physiological and behavioral, and the factors that influence these changes
  35. Nutrition Contributes to Life Expectancy
    • Cumulative effects of lifelong dietary habits determine nutritional status in old age
    • CDC suggest that longevity depends on:
    • 10% access to health care
    • 19% genetics
    • 20% environment (pollution, etc.)
    • 51% lifestyle factors (besides not smoking, a healthy diet & ample exercise contribute most to longevity)
  36. Aging: Cardiovascular
    • Less arterial elasticity, decreased blood flow, heart muscle contraction is diminished and cardiac output falls
    • Blood flow to coronary arteries is decreased - can lead to hypertension and less ability to exchange gases and increase oxygen intake
  37. Aging: Endocrine System
    • Decrease in growth hormone and IGF-1
    • -Affect muscles and muscle function
    • -Stay physically active to reduce muscle loss
    • Decrease in estrogen-menopause
    • Decrease in testosterone -andropause
    • Decreased synthesis of vitamin D from UV light
    • Increases in PTH
    • Need to maintain calcium levels, increase vitamin D levels, and decrease calorie intake
  38. Aging & Bone Loss
    • Lack of vitamin D, low sunlight exposure, and diminished synthesis of vitamin D
    • Leads to decrease of 25(OH)2D
    • Leads to decrease production of 1,25(OH)2D
    • Leads to decrease in calcium absorption
    • Leads to secondary hyperparathyroidism
    • Leads to bone loss and fracture risk
  39. Bone Loss in Elderly
    • Estrogen deficiency
    • Poor vitamin D status
    • Both affect bone remodeling
  40. Aging: Body Composition
    • Weight gain (weight and BMI peak from 50-59 years of age)
    • Decreased bone mass
    • Increased body fat (obesity is associated with functional disability and lower quality of life)
    • Decrease in fat-free tissue of about 15% from age 20 to 70 (lean mass; need to decrease caloric intake); sarcopenia
  41. Normal Aging
    Changes that occur in all individuals are considered age-related 
  42. Successful Aging
    Age-related changes have not been augmented by other influences, perhaps delayed
  43. Potential for Successful Aging
    • Weight gain
    • Sarcopenia
    • Cognitive Function: can range from simple memory deficit to AD; may be related to B-vitamins; B-12, folate
    • -High levels of homocycteine may be involved in cognitive function; could be related to vascular function
    • -Cognitive function may be related to antioxidants; vitamin E, C
  44. Sarcopenia
    • The loss of muscle mass and strength in concert with biological aging
    • ~ 20-40%
  45. Exercise & Sarcopenia
    • Resistance training increases muscle mass and strength
    • The type, frequency, and duration of training is still uncertain
  46. Aging: Gastrointestinal Tract
    • Esophagus - peristaltic waves altered; lower sphincter weakened; gastric reflux
    • -Experience nausea, heartburn and constipation (smaller meals and earlier in the evening)
    • Slower Peristalsis
    • Reduced secretion of HCL and digestive enzymes; greater prevalence of atrophic gastritis; may effect absorption of B-12, folate, iron and calcium; B-12 requirement increased from 2.0 ug to 2.4 ug because of malabsorption
    • Decreased lactase secretion - may decrease milk and dairy consumption, especially calcium and vitamin D
  47. Aging: Oral Tract
    • Dental caries, periodontal disease, loss of bone in the upper and lower jaw, decreased fluid secreting cells (saliva)
    • Missing or improperly fitting teeth
    • Complete tooth loss has decreased dramatically since the early 70s (46% vs 21%)
  48. Aging: Nervous System
    • Brain: neurons are lost and blood flow to brain decreases; reduced nerve conduction velocity; affects taste, smell, touch, cognition
    • Blunted thirst and appetite regulation-older individuals are less likely than their younger counterparts to adjust to under- or over-feeding
    • Decreased neuromuscular function may impair muscular
    • performance
  49. Aging: Renal System
    Loss of nephrons and 30% decrease in blood flow; slowed glomerular filtration rate
  50. Aging: Nutritional Risk Factors
    Hunger, poverty, inadequate food and nutrient intake, functional disability, social isolation, living alone, specific urban and rural demographic area, depression, dementia, dependency, poor oral health, polypharmacy, minority status, advanced age
  51. Aging: Nutrition Screening Initiative
    • Consortium of health care providers, researchers and policy makers
    • Sponsored by the American Academy of Family Physicians, American Dietetic Association and National Council on Aging
    • Developed a list of warning signs for nutritional risk
    • DETERMINE checklist
  52. DETERMINE Checklist
    • 0-2: good
    • 3-5: moderate risk
    • 6+: at high risk
  53. Aging: Mini Nutritional Assessment
    • A valid nutrition screening and assessment tool that can identify geriatric patients ≥ 65 years of age who are malnourished or at risk of malnutrition
    • Combines 6 screening questions in stage 1 with 12 assessment questions in stage 2
    • More extensive than the DETERMINE checklist & includes:
    • -Mid-arm & calf circumferences
    • -Questions related to lifestyle
    • -Medications
    • -Dietary intake
    • -Anthropometrics
    • -Blood chemistries
  54. Aging: Nutritional Assessment- Anthropometric
    • Assess body weight
    • Measure stature/knee height/total arm length/arm span
    • Measure arm circumference
    • Skinfolds; bioelectrical impedence; DXA
  55. Aging: Nutritional Assessment- Dietary Intake
    • Food and beverage intake - either FFQ or dietary records; use food guide pyramid
    • Food preferences
    • Food security/insecurity - access to enough food/uncertain availability of food
    • Use of supplements
  56. Aging: Clinical
    • Signs and symptoms
    • Functional status - Activities of Daily Living and Instrumental Activities of Daily Living
    • Cognitive status - Look for dementia; progressive loss of mental function caused by physiological changes or disease
    • Oral health - dentures, missing teeth, swollen gums, dry mouth, difficulty chewing
    • Use of medications
  57. Aging: Physical Health Status
    • Two instruments were developed
    • Activities of Daily Living Instrument
    • Instrumental Activities of Daily Living
  58. Physical Health Status: Activities of Daily Living Instrument
    • Relate to personal care:
    • -Bathing
    • -Dressing
    • -Feeding oneself
    • -Using the toilet
    • -Transferring between bed and chair
  59. Physical Health Status: Instrumental Activities of Daily Living
    • Assess the ability to perform household and social tasks:
    • -Meal preparation
    • -House cleaning
    • -Handling money
    • -Shopping
    • -Using the phone
  60. Aging: Biochemical
    • Cholesterol, LDL
    • B12 & folate status - MMA, serum and RBC folate
    • Iron status - hemoglobin, serum ferritin, transferrin saturation
    • Protein status - serum albumin and transferrin
    • Vitamin D status - 25-(OH)D3
  61. Aging: MyPlate
    • Addition of fluids/water
    • Addition of physical activity
  62. Aging: Dietary Recommendations
    • Intended for independently living older adults
    • Energy needs decline, but nutrient requirements stay the same or similar as younger adults
    • Focus on nutrient dense foods, bright-colored vegetables and deep colored fruits, whole grains, low and non-fat dairy, dried beans and nuts and lean meats fish and eggs, liquid vegetable oils and soft spreads low in trans and saturated fats and spices to replace salt
    • Fluids such as water and non-fat milk
    • Physical activity such as walking, resistance training and light cleaning
  63. Aging: Nutrition Recommendations
    • Energy- 50+ years; 2300 kcal, males and 1900 kcal females - varies considerably
    • CHO- choose fiber rich fruit and vegetables often
    • Protein- 77 grams for males and 65 grams for females 70+ years; consider calorie intake, protein quality
    • Fat- Keep fat intake between 20-35% of the calories, with most of the fat coming from PUFAs and MFA
  64. Aging: Vitamin D
    • RDA is 600 IU for individuals 51-70 years of age and 800 IU for those 70+
    • Can get from the diet including fortified foods, but may need to consume extra vitamin D from supplements
  65. Aging: Calcium
    • 1000 mg for 51+ years of age males and 1200 for 51+
    • females
    • For those 70+, 1200 mg 
  66. Aging: Vitamin E
    15mg
  67. Aging: Folate
    400 mcg
  68. Aging: B-12
    2.4 mcg; over 50 years of age should consume B-12 in the crystalline form (i.e., supplements and fortified foods)
  69. Aging: Fluid Recommendations
    • The total amount of water decreases with age, resulting in a smaller margin of safety for staying hydrated
    • ≥ 6 glasses of fluid/day will prevent dehydration in most older adults
    • To individualize fluid recommendations, 1 mL of fluid/kcal consumed, with a minimum of 1500 mL
  70. Aging: Food Safety Recommendations
    • Older adults are vulnerable to foodborne illness because they have compromised immune systems
    • Leading hazardous practices:
    • -Improper holding temperatures
    • -Poor personal hygiene
    • -Contaminated food preparation equipment
    • -Inadequate cooking time
  71. Aging: Physical Activity Recommendations
    • 150 minutes of moderate intensity aerobic activity per week or 75 minutes of vigorous aerobic activity per week
    • Muscle-strengthening activities 2 days per week; activities that strengthen all major muscle groups
    • Can be done at 10 minute increments
  72. Concerns Leading to Community Food & Nutrition Programs for Elderly
    • Health Disparities
    • Decreased Functional Capacity
    • Food Insecurity and Hunger
    • Isolation
    • Decreased Appetite
    • Dehydration
  73. Older Americans Act
    • Passed in 1965
    • Regulated by the Administration on Aging
    • Purpose:
    • -Reduce hunger and food insecurity
    • -Promote socialization of older individuals, promote the health and well-being of older individuals
    • -Delay adverse health conditions through access to nutrition and other disease prevention and health promotion services
  74. Congregate Nutrition Services
    • Established 1972
    • Services:
    • -Meals
    • -Nutrition screening
    • -Education
    • -Nutrition assessment and counseling as appropriate
    • 60 or over and the spouse of an older individual regardless of age
  75. Home-Based Nutrition Services
    • Established 1978
    • Services:
    • -Meals
    • -Nutrition screening
    • -Education
    • -Nutrition assessment and counseling as appropriate
    • 60 or over and homebound and the spouse of an older individual regardless of age
  76. Nutrition Services Incentive Program
    • 1974 under USDA
    • -Commodities
    • -1977: Cash or Commodities
    • -Transferred to Administration on Aging in 2003
    • Supplemental Funding
    • States apply for grant
    • Provide money and service for food services only
  77. USDA Nutrition Programs for Elderly
    • Supplemental Nutrition Assistance Program (SNAP)
    • Commodity Supplemental Food Program
    • Emergency Food Assistance Program
    • Child and Adult Care Food Program
    • Senior Farmers’ Market Program
  78. Xerostomia
    Dry mouth
  79. Dysgeusia
    Loss of taste
  80. Glossodynia
    Pain in the tongue
  81. Candidiasis
    Yeast infection
  82. Elderly- GERD
    • Occurs when stomach contents flow back into the esophagus
    • Prevalence
    • -1/5th of older adults
    • Etiology and Effects
    • -Lower esophageal sphincter weakened, possible due to acid in the esophagus
    • Nutritional risk factors
    • -Alcohol
    • -Obesity
    • -Smoking
    • -Coffee (regular & decaf)
    • Nutritional remedies
    • -Omit foods that cause discomfort—varies from person to person
  83. Elderly: Vitamin B12 Deficiency
    • Pernicious anemia—due to lack of the intrinsic factor
    • Food-bound malabsorption, often due to hypochlorhydria
  84. Elderly: Food-Bound Malabsorption of B12
    • Most commonly results from abnormal stomach function such as bacterial overgrowth
    • B12 is not digested, absorbed, or bacteria may use B12 for own metabolism
    • Prevalence
    • ~20% of those > 69
    • Effects
    • -Irreversible neurological damage, walking & balance disturbances
    • Risk factors
    • -Advanced age
    • -GI disorders
    • -Genetics
    • -Medication
    • -Inadequate food intake
    • Nutritional remedies
    • Oral pharmacological doses of 0.2-1 mg  synthetic B12 /d
  85. Elderly: B12 Deficiency- Pernicious Anemia Signs
    Large, pale red blood cells, neurological problems
  86. Eldery: Constipation
    • No one definition
    • Prevalence—depends on definition
    • Etiology- decreased muscle strength, chewing problem, decreased fiber, etc.
    • Effects- possible diverticulitis
    • Risk factors
    • -Decreased fluid intake
    • -Decreased amounts of food
    • -Medication
    • -Iron supplements
    • Nutritional remedies
    • -Increase dietary fiber & fluids
  87. Dementia
    A progressive cognitive decline, characterized by impaired thinking, memory, decision-making, & linguistic ability
  88. Alzheimer's Disease
    • A neurodegenerative disease that is typically found in people > 65 years of age; the most common type of dementia
    • Plaques with misfolded peptides are formed years before the clinical signs appear
    • Use min-mental state examination as part of the protocol to diagnose
  89. Nutritional Prevention of Alzheimer's Disease
    • B-vitamins
    • Curcumin in curry
    • Omega-3- fatty acids
    • Fresh fruit and vegetables
    • Vitamins E + C
    • Moderate consumption of alcohol
  90. Elderly: Cognitive Disorders
    • Etiology of cognitive disorders
    • -A variety of conditions cause
    • Effects of cognitive disorders
    • -Confusion, anxiety, agitation, loss of oral muscular control, impairment of hunger or appetite regulation, changes in smell & taste, dental, chewing, & swallowing problems
    • Nutritional interventions for cognitive disorders
  91. Toddler
    • 1-3 years old
    • Characterized by rapid increase in gross & fine motor skills
  92. Preschool
    • 3-5 years old
    • Characterized by increasing autonomy, broader social circumstances, increasing language skills, & expanding self-control
  93. Toddlers: Physical Growth
    • Rapid rate of growth in infancy is followed by a deceleration of growth
    • Lean mass increases and fat mass decreases with age
    • Bone mineral is increasing
  94. Normal Growth & Development of Children
    • From birth to 1 year, average infant triples his birthweight
    • Toddlers gain 8 oz and grow 0.4 inches per month 
    • Preschoolers gain 4.4 lb and grow 2.75 inches per year 
  95. BMI
    • weight (kg)/height (m)2
    • An effective screening tool; it is not a diagnostic tool
    • For children, it is age and gender specific, so BMI-for-age is the measure used
  96. Childhood Growth
    • Brain growth is completed by 6-10 years
    • Become independent in feeding skills; like to grasp and hold food, finger foods
  97. Monitoring Children's Growth
    • Use calibrated scales & height board
    • Toddlers under age 2 years
    • -Weighed without clothes or diaper
    • -Determine recumbent length
    • Children over age 2 years
    • -Weighed with light clothing
    • -Measure stature with no shoes 
  98. Recumbent Length
    The length of toddlers <24 months are measured in the recumbent position
  99. WHO Growth Standards
    • Growth standards for children from birth to 5 years.
    • International growth standards regardless of ethnicity or socioeconomic status
  100. Physiological & Cognitive Development: Toddlers
    • A time of expanding physical and developmental skills
    • Walking begins as a “toddle,” improving in balance & agility
    • Progress by month
    • –15—crawl upstairs
    • –18—run stiffly
    • –24—walk up stairs one foot at a time
    • –30—alternate feet going up stairs
    • –36—ride a a tricycle
  101. Cognitive Development of Toddlers
    • Toddlers “orbit” around parents 
    • Transitions from self-centered to more interactive
    • Vocabulary expands:
    • -10-15 words at 18 months
    • -100 at 2 years
    • -3-word sentences by 3 years
    • Temper tantrums common (the terrible two’s)
  102. Feeding Behaviors of Toddlers
    • Rituals in feeding are common
    • May have strong preferences & dislikes
    • Food jags common
    • Serve new foods with familiar foods & when child is hungry
    • Toddlers imitate parents & older siblings 
  103. Appetite & Food Intake of Toddlers
    • Slowing growth results in decreased appetite
    • Toddler-sized portions average 1 tablespoonper year of age 
    • Nutrient-dense snacks needed but avoid grazing on sugary foods that  limit appetite for basic foods at meals 
  104. Feeding Skills of Toddlers
    • Babies weaned between 9-14 months
    • Begin to eat more solids and drink from a cup
    • Refined pincer reflex – finger foods, utensils
    • Move tongue from side to side
    • Chew in rotary fashion
    • “I do it”
  105. Feeding Skills of Preschoolers
    • Eating solids and drinking from a cup
    • Can use fork and spoon
    • Still messy, but not like toddler years
    • Food safety still a concern
    • Independence and control central issues
  106. WIC Approved Food Packages 2009
    • Less juice for children and women; no juice for infants; less eggs and dairy products
    • More fruits and vegetables; whole grain foods and canned tuna and salmon
  107. Estimated Energy Requirement of Toddlers
    [89 x weight of child (kg) – 100] + 20
  108. DRI for Protein
    • 1-3 years old: 1.1 g/kg/d or 13 g/day
    • 4-8 years old: 0.95 g/kg/d or 19 g/day
  109. Iron Deficiency in Toddlers
    • 7% toddler deficient and 2% anemic – can cause long-term delays in cognitive development and behavior problems
    • Mexican-American children at greatest risk (17% 1-2 yr olds), then African Americans (10%), then white children (6%)
    • Socioeconomic factors: income < 130% poverty level higher risk (12% vs 7%)
    • Healthy People 2012
    • -Reduce incidence in 1-2yr from 15.9% to 14.3%
    • -Reduce incidence in 3-4yr from 5.3% to 4.3%
  110. Progression of Iron Deficiency
    • Increased iron requirements or inadequate iron absorption or inadequate intake
    • Decreased iron stores
    • Iron deficiency
    • Iron depletion
    • Iron deficiency signs/symptoms
  111. Iron Deficiency Anemia
    • 1-2 years [Hb] <11.0g/dL, hematocrit < 32.9%
    • 2-5 years [Hb] <11.1g/dL, hematocrit < 33%
  112. Prevention & Treatment of Iron Deficiency
    • Don’t drink >24 oz milk/day
    • High risk children checked between 9-12 months, 6 months later, annually to 5yr
    • Treatment
    • -Iron drops 3mg/kg/day
    • -Parental counseling
    • -Repeat screening every 4 weeks
  113. Toddlers: Dental Caries
    • ~1/5 of 2-4 year olds have tooth decay
    • Primary cause is Baby Bottle Tooth Decay
    • If  flouride is not in water, supplement recommended as well as brushing with toothpaste with flouride
  114. Toddlers: Constipation
    • “Stool holding” develops in some children
    • Can begin a cycle of constipation
    • Provide adequate fiber for age
    • Whole grains, legumes, fruits, and vegetables
    • Provide plenty of fluids
  115. Toddlers: Lead Poisoning
    • High blood levels cause decreased growth and disfunction of brain, blood, kidney, other tissues
    • Lower levels cause decrease in IQ & behavioral problems
    • Primary risk – houses built before 1950
    • Iron deficiency amplifies problem
    • High Ca intake can decrease problem
  116. Toddlers: Food Security
    • Access to an adequate supply of safe, nutritious foods
    • HP 2010: increase food security from 88% to 94%
    • Young children are vulnerable due to high nutrient needs and dependence on parents and caretakers
    • Children who have experienced hunger exhibit more behavioral, emotional, and academic problems
    • In 2012, in Georgia, 25% of children live in poor families (less than $21,000 income for a family of 4)
  117. Toddlers: Food Safety
    • Children are particularly vulnerable to food poisoning
    • Campylobacter highest in children <1 yoa
    • -Raw/undercooked poultry, raw milk, infected animal/human feces
    • E.coli more common in children <10 yoa
    • -Contaminated, undercooked hamburger meat and unpasteurized apple juice and milk 
  118. WIC Program Nutrition Assessment
    • Value Enhanced Nutrition Assessment (VENA)
    • For women and children 2-5 years of age
    • Determine eligibility and provide individualized nutrition assessment
    • Provide consistent quality assessment
  119. 2012 School Lunch Guidelines
    • Calorie limits
    • More fruit and vegetables
    • Skim or 1% milk
    • 50% of grains be whole grains; after 2 years, 100%
    • Limit sodium
    • No trans fat
  120. Physical Activity Recommendations 2008
    • 60 minutes or more/day; aerobic activity should be the majority; include vigorous 3/wk
    • Muscle strengthening -3/wk-push-ups, sit-ups, climbing trees, gymnastics
    • Bone strengthening-include activities like jumping rope or running, basketball, volleyball
  121. Schools & Nutrient Interventions
    • Best potential to reach all children
    • Combine PE & nutrition messages
    • There are existing resources
    • Pre-, Elementary, Middle, High, & After School
  122. CATCH
    • Largest field trial of school-based health promotion ever funded in US (NIH)
    • 96 schools (3rd grade) in CA, LA, MN, TX
    • Modified school cafeteria food, PE, classroom health curricula and provided family and home based programs
  123. CATCH Results
    • Percent calories from fat decreased in school lunches and the intensity of physical activity increased in PE
    • Students self-reported reduced daily energy intake from fat and more daily vigorous physical activity
    • Five years after the intervention ended, programs were still being sustained
    • Success was associated with staff training, a program champion and administrative support, including funds for materials and equipment
  124. SMART
    • Exposure to violent media causes kids to be more aggressive
    • TV & video game use causes weight gain
    • TV advertising affects children's preferences and the products they ask for
    • Young teens who watch more TV start to drink alcohol earlier
    • Heavy television viewers do worse in school 
  125. SMART Intervention
    • Conducted a randomized controlled trial over the school year
    • Intervention consisted of 3rd grade curricula and parent handouts designed to motivate students to reduce TV viewing and use of video games
  126. SMART Results
    • Had a relative decrease in:
    • Body mass index 
    • Triceps skinfold thickness
    • Waist-to-hip ratio
    • TV viewing & video game use
    • Frequency of eating meals in front of a TV
  127. Nutrition & Prevention of CVD in School
    • Acceptable range for fat is 25% to 35% of energy for ages 4 to 18 year
    • Include sources of linoleic (omega-6) and alpha-linolenic (omega-3) fatty acids
    • Limit saturated fats, cholesterol & trans fats
    • Increase soluble fibers, maintain weight, & include ample physical activity
    • Diet should emphasize:
    • -Fruits and vegetables
    • -Low-fat dairy products
    • -Whole-grain breads and cereals
    • -Seeds, nuts, fish, and lean meats
  128. Eating & Feeding Problems
    • Cystic fibrosis        
    • Diabetes mellitus
    • Seizures
    • Cerebral palsy
    • Phenylketonuria (PKU)
    • Attention deficit hyperactivity disorder (ADHD)
    • Pediatric HIV
  129. Adolescence
    Period between 11 & 21 years of age; a time of profound biological, emotional, social, and cognitive changes
  130. Puberty
    Time frame during which the body matures from that of a child to an adult
  131. Adolescence- Nutritional Needs
    • Biological, psychosocial and cognitive changes affect nutritional status
    • Rapid growth increases nutrient needs
    • Desire for independence may cause adoption of health compromising eating behaviors
  132. Adolescence- Physical Growth & Development
    • Puberty occurs during early adolescence
    • Biological changes of puberty include:
    • -Sexual maturation
    • -Increases in ht & wt
    • -Accumulation of skeletal mass
    • -Changes in body composition
    • The sequence of maturation events is consistent but great individual variation in age of maturation 
  133. Sexual Maturation Rating
    • Scale of secondary sexual characteristics used to assess degree of pubertal maturation
    • -SMR 1= prepuburtal growth & development
    • -SMR 2-4 = occurrences of puberty
    • -SMR 5 = sexual maturation has concluded
  134. Early Adolescence
    • Emotional related- adjustment to new body image, adaptation to emerging sexuality
    • Cognitively related- concrete thinking, early moral concepts
    • Socially related- strong peer effect
  135. Middle Adolescence
    • Emotional related- establishment of emotional separation from parents
    • Cognitively related- emergence of abstract thinking, expansion of verbal abilities and conventional morality, adjustment to increased school demands
    • Socially related- increased health risk behavior, early vocational plans
  136. Late Adolescence
    • Emotional related- establishment of a personal sense of identity, further separation from parents
    • Cognitively related- development of abstract, complex thinking, emergence of post-conventional morality
    • Socially related- increased impulse control, emerging social autonomy, establishment of vocational capability
  137. Nutrient Intake of Adolescents
    • U.S. adolescents have inadequate intake of vitamins & minerals including:
    • -Folate
    • -Vitamins A, B6, C, & E
    • -Iron & zinc
    • -Magnesium
    • -Phosphorus & calcium
  138. Factors Affecting Physical Activity in Adolescents
    • Adolescents more likely to be physically  activity if they have:
    • -Confidence in ability to exercise
    • -Positive perceptions of activity or sports
    • -Positive attitudes toward activity
    • -Peer & family support
    • -Safe & convenient places to play
    • -Sports equipment
    • -Transportation to sports or fitness programs
  139. LEAP
    • Change instructional programs and school environments to increase physical activity among 9th grade girls
    • Targeted PE, health education, school environment, school health services, faculty/staff health promotion, and family/community involvement
    • A two-year intervention conducted in 24 high school in South Carolina
  140. Adolescents' BMI & Body Image
    • Significant weight changes
    • Growth; BMI > 95 or < 5th
    • Overly concerned about body size
  141. Adolescents' Eating Behaviors
    • Poor appetite
    • Excess fast foods
    • Skip meals > 3/wk
    • Practice unhealthy weight control behaviors
    • Consumes vegetarian diet without knowledge of meal planning
  142. Adolescents' Physical Activity
    • Inactive: < 5 days/wk; assess TV viewing time
    • Excessive physical activity
  143. Adolescents' Medical Conditions
    • Chronic diseases
    • High blood lipids
    • Dental caries
    • Pregnant
    • Taking medication
    • Taking supplements
  144. Issues for Adolescents
    • Overweight
    • Athletic Nutrition
    • Eating Disorders
    • Substance Use
  145. Anorexia Nervosa
    Characterized by extreme weight loss, poor body image, and irrational fears of weight gain and obesity
  146. Bulimia Nervosa
    • An eating disorder characterized by recurrent episodes of rapid, uncontrolled eating of large amounts of food in a short period of time
    • Episodes of binge eating are often followed by purging
  147. Exclusive Breastfeeding
    • Only breast milk
    • No solids or other forms of liquid
  148. Formula Supplementation
    Supplementation of breast milk with formula (with or without other supplementary liquids or solids) among infants breastfed at the age specified (2 days, 3 months, or 6 months)
  149. Obesity & Breastfeeding
    • High prevalence of childhood obesity in the US
    • ›Breastfed infants may be less likely to become overweight or obese as adults
  150. Association of Breastfeeding & Childhood Overweight 
    • Reviewed 9 studies
    • Reported BMI for children 5-18 years old
    • Each study adjusted for ≥3 confounding factors
    • Odds ratio (OR) indicated a protective effect of breastfeeding against overweight
  151. Potential Effects of Breastfeeding Duration
    • Reviewed 17 studies
    • Studies correlated incidence of childhood overweight and duration of breastfeeding from <1 month - >9 months (split into 5 categories)
    • OR indicated risk of overweight continuously decreased by breastfeeding duration

    ›
  152. Effect of Breastfeeding on Mean BMI
    • Reviewed 11 studies
    • Compared BMI of 1-70 year old breastfed subjects to those formula fed
    • After adjusting for confounding factors no effect was observed
    • Authors concluded that “breastfeeding not likely to reduce BMI”
  153. Limitations of Observational Studies
    • Publication bias
    • ›Potential heterogeneity
    • ›Residual confounding
  154. Promotion of Breastfeeding Intervention Trial
    • ›The only interventional study
    • ›Assigned women to a breastfeeding promotion and observed for 12 months
    • ›16,491 participants originally enrolled 13,389 followed-up at 6.5 years
    • ›Successful at initiating breastfeeding
    • ›Findings not statistically significant with respect to body composition
  155. Duration of Breastfeeding
    • Each additional month of breastfeeding reduced risk of becoming overweight in adulthood by 4%
    • •Up to 9 months
    • ›Breastfeeding for ≥16 weeks reduced the risk of obesity at 4 years of age
  156. Feeding Practices
    • Breastfed infants are typically leaner
    • •Ability to self regulate intake
    • -Breastfeeding allows the infant to control the amount of milk consumed
    • -FF infants consume more and gain weight more rapidly
    • 3.2 times > risk of rapid weight gain between ages 2-6 years ›
    • Breastfeeding may induce lower plasma insulin levels
    • •Decreases fat storage and prevents excessive early adipocyte development
    • •FF infants have higher plasma insulin levels,
    • stimulating fat deposition and formation of adipocytes
    • Higher protein in formula may stimulate higher insulin secretion
    • Breastfeeding has been shown to promote slower infant growth velocity
    • •FF stimulates greater postnatal growth with adiposity rebound occurring earlier
    • The higher protein content of formula maybe responsible

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